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An FM Patient Counselor’s Primer on the Guaifenesin Protocol

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Claudia Marek is Medical Assistant to FM specialist R. Paul St. Amand, MD – director of the Los Angeles-based Fibromyalgia Treatment Center, Assistant Clinical Professor of Medicine in Endocrinology at UCLA, and developer of the Guaifenesin Protocol for Fibromyalgia. This article is excerpted with kind permission from Claudia's classic book The First YearFibromyalgia.*


The Guaifenesin Protocol: A Possible Treatment Option
By Claudia Craig Marek

In 1994 a bit of serendipity brought a medication called guaifenesin to Dr. St. Amand’s attention. In a short period of time it proved more effective than any of his previous Fibromyalgia medications with a wonderful postscript – it had no side effects! Guaifenesin: (gwy-FEN-e-sin) is an expectorant that thins mucus and helps to loosen phlegm.

While researching medications for Fibromyalgia, you’ll probably come across a treatment using a medication called guaifenesin [a prescription medication until July 2002 and now sold as branded retail products in various strengths and delivery modes**]. Since this has proven effective for many Fibromyalgics, it is worth looking at. You should know that this treatment is experimental, although guaifenesin has been on the market for many years and used for other illnesses. To date there has been no successful double-blind study of its use for Fibromyalgia, but you will read that it has helped many people…

The Guaifenesin Protocol

The Guaifenesin Protocol is the work of R. Paul St. Amand, MD, an endocrinologist in Marina del Rey, California, who has dedicated over 40 years of his life to treating Fibromyalgia. He himself, as well as several members of his family, have the illness.

Dr. St. Amand believes that Fibromyalgia is an energy-deprivation disease.

He postulates that it’s the inability of each cell to make abundant energy that is the cause for all the symptoms we experience, and this is why so many systems in our body malfunction simultaneously. Without enough energy, all our systems function marginally and we have many complaints. He believes that this underproduction of ATP [adenosine triphosphate] is caused by a slight excess of phosphate inside the cells' power stations, known as the mitochondria.

How guaifenesin works

According to Dr. St. Amand, taking guaifenesin starts a reversal process in Fibromyalgia by causing the kidneys to pull the excess phosphates from cells.

This causes all of your symptoms to come and go in turn: pain, fatigue, fibrofog, irritable bowel and bladder. Symptoms will exacerbate, diminish, and then clear in this cyclical fashion. Eventually, as time progresses, you become asymptomatic.

There is a specific way to find your dose of guaifenesin

When you start guaifenesin, the proper way to begin is with 300 mg twice daily. You should remain at 300 mg twice a day for one week. If you feel distinctly worse within a few days of starting your guaifenesin, you have started your reversal and there is no need to change your dose.

Don’t be discouraged if you don’t feel any differently during this first week. The fact is that the vast majority of patients don’t. Six hundred milligrams a day will only reverse Fibromyalgia in about 20% of people, according to Dr. St. Amand.

At the end of the first week on guaifenesin, if you have felt no differently, you should raise your dose. The correct way to do this is by moving up to 600 mg twice a day, or doubling the dose you started at.

Dr. St. Amand has his patients stay at this higher dose for three more weeks. Again, a worsening of symptoms indicates that you have begun your reversal. If this is the case, you would stay at this dose, and not change it. Roughly 50% of patients start reversal at this level.

Let’s say you’re one of the 30% of people who hasn’t felt any worse after a month on 1200 mg of guaifenesin. It’s normal to be afraid that this is just another treatment that isn’t going to work for you, but you should just raise your dose to three pills a day. At this point it’s highly likely that your symptoms will exacerbate. Only 10% of patients will need more guaifenesin, and will have to raise their dosage still higher, to 2400 mg a day.

Once you find the dose that causes your symptoms to escalate, there’s no need to change it. All you have to do is continue to take guaifenesin. Your symptoms should cycle – that is, get better and then worse, better and then worse. Like a bouncing ball, they will get less dramatic, and good periods will become more pronounced. Eventually you should have all your symptoms under control.

You’ll need to learn about salicylates

Guaifenesin’s effect on the kidney is blocked by the chemical salicylate. Renal tubules, where the guaifenesin must act, have receptors just like other cells, and salicylates and guaifenesin compete for the same sites. Just as pain signals are blocked when pain medications dock in pain receptors, guaifenesin is blocked when salicylates park in the receptors it uses.

Avoiding salicylates means reading labels. It means you’ll have to know what is in all the products you are using in and on your body. Both synthetic salicylates, like aspirin-containing medications, and some topical exfoliants and natural salicylates, like plant oils, gels, and extracts, will block guaifenesin’s action.

Guaifenesin blockers

Salicylate, salicylic acid, octislate in medications or topical products

Oils with plant names (except soy, wheat, corn, oats)

Gels with plant names (except soy, wheat, corn, oats)

Extracts with plant names (except soy, wheat, corn, oats)

Mint flavor, mint oil, menthol

Plant compounds such as camphor, bisabol, pycnogenol®, or bioflavinoids

All herbal medications.

Before you try guaifenesin, decide if it’s right for you

There are several excellent sources for more information about using guaifenesin. I recommend you read the book I coauthored with Dr. St. Amand  (What Your Doctor May Not Tell You About Fibromyalgia). [And for answers to many of the questions other patients have asked about the protocol, see Q&A Session with Dr. St. Amand in ProHealth's library.]

On the Internet, you’ll find Dr. St. Amand’s papers and more information at Because Guaifenesin has not been approved by the FDA for this still experimental application, it should be used as such only with the approval and supervision of a medical doctor familiar with the patient and Protocol. Importantly, this site offers a state-by-state listing of medical professionals who have stated they’re familiar with the Guaifenesin Protocol and have offered their contact information for interested patients. [Though it is not possible to ensure all this information is up-to-date, the list should provide a useful starting point.]

* The First Year – Fibromyalgia, 2003, Marlow & Company, New York; © Claudia Marek.

** The Fibromyalgia Treatment Center site provides an overview of guaifenesin sources [including Muxinex™ by Adams Labs (the FDA approved time released guaifenesin 600 mg), and a 400 mg fast acting product for additional dosing].

Note: The information in this article is not meant to diagnose, alleviate, treat, cure, or prevent any illness, condition, or disease, and has not been evaluated by the FDA. It is very important that you make no change in your healthcare plan or health support regimen without the careful collaborative review and approval of your professional healthcare team.

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4 thoughts on “An FM Patient Counselor’s Primer on the Guaifenesin Protocol”

  1. hearbetty says:

    If it’s been at least 9 years since Dr.St Armad has been using this protocol, why has he not conducted a double-blind study to prove it’s efficiacy and put to rest the scepticism in the medical community?

    Patients want to try something that works but since most of us are barely or not working and ALL of these recommendations require MONTHS of trying supplements (their most effective dose of 600mg/2x day cost $50 for 50 tablets) plus purchasing lots of new salicylate-free products) we can scarcely afford them. Insurance will not cover it until its proven. Surely as an M.D. he could generate some private funding after all these years of word-of-mouth successful results from his patients? Can the writer of this article comment on this?

  2. robert-sydney says:

    I am sorry to see that you had to wait so long to get any feedback here. I am probably speaking for many of those who are simply to tired to even type anything due to the amount of research and trying we all done before finding this miracle drug. It is 12.30am here in Australia and I am so tired to type this but this is the least I can do for all what that drug did for me. I strongly suggest you visit Dr. Amand website and subscribe to the forum.You can check archive for my comments under robert-sydney to learn about me. I lost all in my life, wife, houses, job etc.Guai was the last drug I tried and it saved my life.I was diagnosed with sever case of fms, could barely open my mouth due to pain and stiffness.FMS is caused by many things and Dr. Amand knows it, he asks in his book to check for them, I did before I found his book, so it made sense to me what he wrote.I checked my thyroid, hormones, iron, vit D. I tried T3, iron, testosterone, cymbalta, tramadol, mulnicipran etc. Only Guai worked! The truth is we have no choice but to try, you will see that once the pain gets to its core. Simply try, I noticed 3 ut of 10 FMS sufferers get help with Guai, Im one of them, so far so good, too good I would say,I cant believe how better I am also a long way from normal. Normal sound slike a dream to me mate. God bless (if you still have any fate left) keep trying mate, just keep trying step by step, one medicine after another, I have 4 50Liter boxes of meds. I have a small pharmacy at home he he. But I found it, I found it….

  3. CarolynSoCal says:

    If you look at Dr. St. Amand’s website ( you’ll see that he does have some important studies going on at the City of Hope in Loma Linda, California. His assistant, Claudia Marek, also publishes a newsletter with excerpts from scholarly journals regarding other research on this condition. Again, see their website to subscribe (or read an issue free on-line).

    Dr. St. Amand is well aware of the cost of guaifenesin (although my neighbor recently commented that a bottle of guaifenesin is less than many of the vitamins she buys!) and has worked with suppliers and pharmacists to keep the cost down. He does NOT benefit in any way from the manufacture or sale of guaifenesin.

    I know it can seem like climbing a mountain when you’re so ill and you have been that way for so long but everyone who is diagnosed with FM needs to give the protocol a try. It’s the only hope we have for a true reversal of our symptoms instead of masking them (partially) with so many medications, all of them interacting and causing side effects. There have been so many people who have gotten well! Don’t let the issue you wrote about keep you from this valuable treatment. They have an on-line support group as well with lots of helpful and professional advice.

    Lastly: Yes, you do have to avoid salicylates and for some that can mean buying new toiletries and personal products. But the initial things you may need to buy are simple: shampoo, hand soap, lotion. You don’t have to use 100 products and in fact, dermatologists say it’s better if we don’t. The other good thing is that the products we can use without plant extracts or oils are way less expensive!

    I cannot urge all of you with fibromyalgia strongly enough: you owe it to yourself to try the Guaifenesin Protocol. Your improvement will not be overnight but it will most likely happen. Go in and read some of the posts on the support group.
    This is real relief for a very serious and disabling condition.
    Personally, I think we’ll see Dr. St. Amand on the cover of TIME magazine one day for his pioneering work in the cause and treatment of this terrible illness.

    A grateful patient of Dr. St. Amand

  4. FifiMcFifi says:

    I am questioning why Guaifenesin is so expensive. The raw material, Guaiacum officials, is a standard part of any Medical Herbalist’s dispensary. They use is, as a tincture usually, or a decoction of the bark (i.e. simmering in water for a time) and combine it with other tinctures in various ways to treat things like arthritis, fibromyalgia, ME, coughs (if thinning of the mucous is appropriate). They have used it for hundreds of years but any straightforward Western Medical Herbalist should stock it. They often combine it with Harpagophytum procumbens (Devil’s claw is the folk name for this herb) or Yucca filaments with great results. You shouldn’t have to pay a great deal, though I suggest you see the practitioner properly rather than just buy herbs from them, as they are heath professionals in their own right, and know their stuff! They exist in the UK, Australia and USA for sure, so give it a go.

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