A Guide to Fibromyalgia Medications

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A Guide to Fibromyalgia Medications

(Information Provided by the National Fibromyalgia

Research Association.)

Presently, no single medication alleviates all of a fibromyalgia patient's

pain and accompanying symptoms. This makes it doubly important for physicians

to keep updated regarding results of ongoing FMS research and current changes

in recommended fibromyalgia treatments. Before medications are prescribed for

a patient, it is the responsibility of the attending physician to elicit a

comprehensive medical history. Because different symptoms accompany each FMS

patient, the doctor needs to know what problems are specific to each

individual. For instance, non-restful sleep is almost always a major concern

for fibromyalgia sufferers. Small doses, usually 10 mg, of antidepressant

medication seems to help many FMS people. However, if after taking a detailed

history, the physician discovers a pattern of sleep myoclonus (nocturnal leg

jerks) medication such as Klonopin or Sinemet at 10-100 mg might be a better

choice. It is important for the physician to encourage the patient to keep a

detailed written journal of medications, dosages, timing and side effects.

This written record will be beneficial to the patient as well as the doctor

when prescribing medication. It takes time and communication between the

health care professional and patient to determine the correct FMS medication,

proper dosages, and appropriate time to take the prescriptions.

Frequently Prescribed Fibromyalgia Medications

http://www.coloradohealthsite.org/fibro/#tri " >Tricyclic

Anti-Depressants

http://www.coloradohealthsite.org/fibro/#ben " >Benzodiazepines

http://www.coloradohealthsite.org/fibro/#ser " >Serotonin-Boosting

Medications

http://www.coloradohealthsite.org/fibro/#mus " >Muscle Relaxants

http://www.coloradohealthsite.org/fibro/#ana " >Analgesics

http://www.coloradohealthsite.org/fibro/#oth " >Other Medications

http://www.coloradohealthsite.org/fibro/fibro_center.html " >Return to

Fibromyalgia Center

TRICYCLIC ANTI-DEPRESSANTS

Amitriptyline - Elavil 2.5mg-50mg PM Cyclobenzaprine - Flexeril

10mg-30mg PM Doxepin - Sinequan 2.5mg-75mg PM Nortriptyline - Pamelor

10mg-50mg PM Trazodone-Desyrel 25mg-50mg PM

Elavil (Amitriptyline) dose is typically 2.5 to 50 mg per night. Elavil is

known for pain relieving effects and ability to help sleep. This medication

should be taken early in the evening, or half-dose in the evening and the

other half at bedtime to avoid morning hangover.

Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic

drug similar to Elavil with muscle relaxant qualities. May be taken along

with Elavil to provide muscle relaxant relief. This medication usually

reaches its maximum effect after one to two weeks of continuous use.

Sinequan (Doxepin) a typical dose is 2.5 to 75 mg. Also a tricyclic that

functions in the body as an antihistamine. Available in tablet form as well

as liquid.

Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar

effects as Elavil but may be less sedating.

Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as

effective as the other anti-depressants, however, is chemically different and

may be less likely to cause side effects. Desyrel may make a sleep problem

worse if combined with a tricyclic anti-depressant at night.

Many of the tricyclic anti-depressants have side effects that may be

intolerable for some people. These include constipation, drowsiness, dry

mouth and eyes, headache, heart rate abnormalities, increased sensitivity to

sunlight, morning " hangover, " and weight gain. These side effects may improve

after patients have been using the medication for a few weeks. If not, the

doctor should be consulted regarding another medication.

http://www.coloradohealthsite.org/fibro/#top " >Return to medications

list.

BENZODIAZEPINES

(anti-depressant and anti-anxiety properties)

Alprazolam - Xanax 0.25mg-1.5mg PM Clonazepam - Klonopin

0.50mg-1.0mg PM

Xanax (Alprazolam) a typical dose is 0.25 to 1.5 mg at night. Xanax has been

found to be more effective if taken with 2400 mg (per day) of ibuprofen.

However, Xanax may cause depression in some people, and has been known to be

addictive. Xanax may be effective for some fibromyalgia patients if taken in

low does.

Klonopin (Clonazepam) 0.5 to 1 mg at night is helpful in sleep myoclonus (arm

and/or leg spasms). Klonopin may help patients who grind their teeth. It

stays active in the body longer, and has the same possibility of being

addictive as Xanax, and may cause depression in some people.

The anti-depressant and anti-anxiety properties of these medications can

cause the following effects: Depression, drowsiness, impaired coordination,

impaired memory, muscular weakness and/or concentration problems, and they

are known to be addictive.

http://www.coloradohealthsite.org/fibro/#top " >Return to medications

list.

SEROTONIN-BOOSTING MEDICATIONS

Fluoxetine - Prozac 1mg-20mg AM Paroxetine - Paxil 5mg-20mg AM

Sertraline - Zoloft 50mg-200mg AM Nefazodone-Serzone 100mg-150mg AM+PM

Venlafaxine-Effexor 37.5mg-150mg AM

Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical

dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be

taken in combination with one of the sedating tricyclics such as Elavil or

Sinequan.

Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the

morning.. This medication is the most potent of this type. A sedating

medication may be needed at night in conjunction with Paxil. It can cause

nervousness, insomnia, nausea, sexual difficulties and sweating, although

many patients report having fewer side effects with Paxil as compared to

Prozac.

Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven

helpful for some patients. Sedating medication may also be needed to combat

insomnia.

Serzone (Nefazodone) is the newest of these agents. As well as increasing

serotonin, it also increases norespinephrine. Serzone's efficacy and side

effects are similar to Effexor.

Effexor (venlafaxine hydrochloride) is not related to the tricyclics or the

Prozac-like drugs, however, it does boost serotonin and has tricyclic

properties. The typical side effects are nervousness, anxiety, insomnia and

increased blood pressure.

The following are some of the side effects of serotonin boosting medications:

anxiety/nervousness, headache, insomnia, mood swings, sexual difficulties,

nausea and stomach distress.

http://www.coloradohealthsite.org/fibro/#top " >Return to medications

list.

MUSCLE RELAXANTS

Orphenadrine Citrate - Norflex 50mg-100mg AM+PM or PM

Cyclobenzaprine - Flexeril 50mg-100mg AM+PM

Norflex (Orphenadreine Citrate) is one to try if the patient does not respond

to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day.

Norflex is a central acting analgesic muscle relaxant that has been found to

decrease pain in some FMS patients. Norflex is most often taken at night,

some patients are able to tolerate this medication in the morning as well.

Patients should be cautioned that muscle relaxants can cause drowsiness and

they should not operate a motor vehicle when taking this type of medication.

There are other muscle relaxants to try if these do not work.

Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help

loosen the tightness of FMS muscles. Flexeril may be taken in combination

with Elavil to provide maximum relief.

http://www.coloradohealthsite.org/fibro/#top " >Return to medications

list.

ANALGESICS, Prescription medications at physicians discretion

Tylenol Tylenol with codeine Vicodin Darvon

Ultram

Analgesics generally recommended are: Tylenol, Tylenol with codeine, Vicodin,

Darvon and Ultram. These medications are prescribed for pain at the

physician's discretion.

These medications are generally prescribed for those requiring a greater

analgesic effect than acetaminophen alone can deliver, and/or those who are

allergic to, or cannot take, aspirin. The role of narcotic pain relievers in

fibromyalgia is to temporarily relieve an exacerbation of FMS pain.

http://www.coloradohealthsite.org/fibro/#top " >Return to medications

list.

Other Medications

Sleep Medications - may be used occasionally during flares or when the

patient is having severe sleeping problems. They can be habit forming,

however, Ambien is thought to be less habit forming, is well tolerated, with

few side effects, and there are no known drug interactions. This sleep

medication should not be used more than two or three times a week.

NSAIDS (anti-inflammatories) Advil, Clinoril, Motrin, Naproxen, Relafen and

Voltaren. Used alone, these anti-inflammatories have not proven effective in

reducing FMS pain. However, Elavil and Xanax's effectiveness is increased

when used in combination with ibuprofen (2400 mg per day). If the patient has

arthritis, osteoarthritis or tendinitis these medications would be helpful in

alleviating the pain. Advil, Motrin, Naproxen, Relafen, etc., are

non-steroidal anti-inflammatories. These medications can cause stomach upset

and some patients have developed bleeding ulcers.

Topical Creams

Zostrix cream (Capsaicin 0.25 percent) a topical analgesic that can be

purchased over the counter. Zostrix is effective for relief of pain of

arthritis in specific areas and has been shown to help FMS patients. It is

suggested that it be used three to four times per day for maximum

effectiveness. Zostrix can be extremely irritating to the eyes, so hands

should be washed well after application. Aurum - is composed of methyl

salicylate, camphor and menthol, and has helped reduce pain in FMS patients