Fibromyalgia - Medications

Medications

Pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella) are approved specifically for treating fibromyalgia. However, many other drugs are used to treat the condition, including antidepressants and muscle relaxants. There is no consensus over which treatment is most useful, or whether a combination of treatments works best. The goal with medication has been to improve sleep and pain tolerance. Medications from other drug classes (such as sleeping aids and pain relievers) may also be prescribed. Patients receive drug treatments in combination with exercise, patient education, and behavioral therapies.

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Anti-Seizure Agents (Anti-Convulsants)

Pregabalin is an anti-epileptic medicine. Also called anti-seizure drugs and anti-convulsants, these medicines affect the chemical messenger gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing.

Research is indicating that pregabalin may improve sleep quality, fatigue symptoms, and fibromyalgia pain. One study found that three different doses of pregabalin -- 300 mg, 450 mg, and 600 mg -- were effective at improving pain and sleep, and all were well tolerated by patients. The most common side effects include mild-to-moderate dizziness and sleepiness. Pregabalin can impair motor function and cause problems with concentration and attention. Patients should talk to their doctor about whether pregabalin may affect their ability to drive.

Studies have shown that another anti-convulsant, gabapentin (Neurontin), which is approved for the treatment of postherpetic neuralgia, affects pain transmission pathways and may relieve pain associated with fibromyalgia. Patients who took gabapentin have reported that they slept better and were less tired.

Antidepressants

The main classes of antidepressants used for treating fibromyalgia are tricyclics, selective serotonin-reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Although these drugs are antidepressants, doctors prescribe them to improve sleep and relieve pain in non-depressed patients with fibromyalgia. The dosages used for managing fibromyalgia are generally lower than dosages prescribed for treating depression. If a patient has depression in addition to fibromyalgia, higher doses may be required.

Tricyclics. Tricyclic antidepressants were the first drugs to be well-studied for fibromyalgia. They may be more effective than SSRIs and SNRIs for fibromyalgia symptoms, although all three drug classes seem to show some effectiveness. Tricyclics cause drowsiness and can be helpful for improving sleep. Research finds that they are also effective for reducing pain, and improving depressed mood and quality of life. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil, Endep), which produces modest benefits with pain and sleep but can lose effectiveness over time. Other tricyclics include nortriptyline (Pamelor, Aventyl), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), and amoxapine (Asendin).