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 Year – Fibromyalgia.*
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.
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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.
• 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 http://www.fibromyalgiatreatment.com. 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.