Fibromyalgia - Medications

Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs). These drugs are also known as dual inhibitors because they act directly on two neurotransmitters---norepinephrine and serotonin.

Duloxetine (Cymbalta) is gaining attention as a treatment for fibromyalgia. In a 2004 study, 207 patients with fibromyalgia were randomized to receive either duloxetine 60 mg twice a day or placebo for 12 weeks. Duloxetine significantly improved pain and tenderness and was effective for both depressed and non-depressed patients. Duloxetine was most effective for women, but very few men were enrolled in this trial.
Venlafaxine (Effexor) is similar to fluoxetine (Prozac) in effectiveness and tolerability for most patients. As with the SSRIs, and unlike other newer antidepressants, venlafaxine impairs sexual function. Although clinical trials have shown that the drug is safe and effective in most people, there have been reports of changes in blood pressure and heart conduction abnormalities, which may cause serious problems in elderly patients. Some patients report severe withdrawal symptoms, including dizziness and nausea.
Milnacipran (Ixel) is under investigation and is not yet approved in the U.S. It is specifically being researched for helping people with fibromyalgia and similar pain syndromes. A Phase III trial evaluating its use as a potential treatment for fibromyalgia is underway. In a 2004 study of 125 patients, milnacipran improved fibromyalgia pain and other symptoms, including fatigue, sleep, and depression.

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Muscle Relaxants

Cyclobenzaprine (Flexeril) relaxes muscle spasms in specific locations without affecting overall muscle function. Drowsiness is the most common side effect. Cyclobenzaprine is related to the tricyclic antidepressants and has similar side effects including dry mouth and dizziness. A 2004 review of five randomized controlled trials found that patients who received cyclobenzaprine were three times more likely to report improvement in fibromyalgia symptoms than patients who received placebo.

Sleep Medications

Zolpidem (Ambien) or other newer sleep medications such as zaleplon (Sonata) and eszopiclone (Lunesta) may improve sleep for patients who suffer from insomnia.

Pain Relievers

Pain relief is of major concern for patients with fibromyalgia.

Tramadol (Ultram), used alone or in combination with acetaminophen, is commonly prescribed for relief of fibromyalgia pain. Its most common side effects are drowsiness, dizziness, and constipation, and nausea. Tramadol should not be used in combination with tricyclic antidepressants.
For relief of mild pain, acetaminophen (Tylenol) is most often recommended. Anti-inflammatory drugs, which are commonly used for arthritic conditions, are less useful for the pain of fibromyalgia, since the pain is not caused by muscle or joint inflammation. Such drugs include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil), and others.
Capsaicin (Zostrix) is an ointment prepared from the active ingredient in hot chili peppers that has been helpful for relieving painful areas in other disorders. It may have some value for fibromyalgia patients.
Opioids, or narcotics, may be used occasionally for certain patients with moderate to severe pain or significant functional impairment who cannot find relief with other, less potent treatments. Some may be given combinations of narcotic pain relievers and acetaminophen for periodic pain. Some physicians prescribe opioids such as oxycodone (Roxicodone) or morphine sulfate (Duramorph) for patients who require ongoing relief. However, the benefit of opioids for fibromyalgia management is highly controversial. Physicians should take a careful medical and psychological profile of the patient before prescribing opioids and periodically reevaluate the patient for continuing pain relief, side effects, and indications of dependence.
Pramipexole, a drug used to treat Parkinson?s disease and restless legs syndrome, may help relieve pain and fatigue in people with fibromyalgia, according to a 2005 study published in Arthritis and Rheumatism. Pramipexole stimulates production of dopamine, a neurotransmitter in the brain. For the randomized controlled study, researchers compared pramipexole with a dummy pill (placebo). After three and a half months, 36% of those who took pramipexole said they felt much better, compared to 9% of those received a dummy pill. Overall, patients had a 50% or greater decrease in pain.
A small 2005 study conducted in Spain suggests that the atypical antipsychotic olanzapine (Zyprexa) may be a beneficial add-on therapy for patients with fibromyalgia. Although proven effective for some chronic pain conditions, olanzapine causes unpleasant side effects. Eleven of the 25 patients in the 2005 study dropped out due to weight gain.