Drugs and Medications for Fibromyalgia

A variety of drugs and medications may treat your symptoms, but understand that fibromyalgia has no known cure. Most medications help treat a portion of the disorder's symptoms. For instance, your doctor may recommend sleeping pills to relieve your insomnia or anti-depressants to improve your mood. Based on your specific symptoms, your doctor will develop the right medication regimen for you.

The FDA has approved three drugs to treat fibromyalgia—pregabalin (marketed as Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). Lyrica is an anti-epileptic, while Cymbalta and Savella are anti-depressants. But these medications are not your only options. In fact, there are a variety of drugs and medications that treat the gamut of fibromyalgia symptoms.

Anti-depressants

About 30% of people with fibromyalgia also have depression or some form of mood disturbance. In many cases, anti-depressants are used as a first line of defense in fibromyalgia treatment. Doctors usually prescribe one or a combination of anti-depressants from three classes—tricyclic anti-depressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs).

• Tricyclic anti-depressants: They improve mood, reduce pain, and address sleep issues by raising levels of calming neurotransmitters in the brain. Possible side effects include drowsiness, dizziness, dry mouth and eyes, and constipation. Amitriptyline hydrochloride (Elavil) and nortriptyline (Pamelor) are examples of tricyclic anti-depressants.
  
• SNRIs: This class of anti-depressants increases serotonin and norepinephrine by stopping their reuptake (reabsorption) into brain cells. Increased levels of these chemicals help maintain mental balance and reduce the amount of pain you feel. Side effects include dizziness, insomnia, and drowsiness, so your doctor may also prescribe a tricyclic anti-depressant to curb any sleep disruptions. Cymbalta and Savella are examples of SNRIs.
  
• SSRIs: Among the newer types of anti-depressants, they boost your mood by allowing more serotonin to travel from neuron to neuron. More serotonin means less pain perception. (SSRIs are very similar to SNRIs—the main difference being that SNRIs deal with serotonin and norepinephrine.) SSRIs may help reduce your fatigue, which is one of the most debilitating fibromyalgia symptoms. SSRIs, however, are not flawless. Like SNRIs, they may interfere with sleep, so your doctor may also prescribe a tricyclic anti-depressant to prevent sleep disturbances. Fluoxetine hydrochloride (Prozac) and sertraline hydrochloride (Zoloft) are SSRIs.

Anti-epileptics

Lyrica is an anti-epileptic (or anti-convulsant) that also happens to be the first FDA-approved drug to specifically treat fibromyalgia. It's not exactly known how Lyrica works in relation to fibromyalgia, but research suggests that it decreases excess pain signals sent by damaged nerves, thus reducing the pain you feel.

Other anti-convulsants, such as gabapentin (Neurotontin), have also been used to treat symptoms associated with fibromyalgia, including TMJ (temporomandibular joint disorder) and myofascial pain.

Muscle relaxants

The muscle relaxant cyclobenzaprine (Cycloflex and Flexeril) is often used early on in fibromyalgia treatment to relax tense muscles and promote quality sleep. Muscle relaxants may also successfully reduce TMJ and other aches and pains associated with fibromyalgia.

Other Medications

• Over-the-counter options such as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, are not considered effective in treating fibromyalgia's symptoms when taken as a stand-alone medication. But when used with another fibromyalgia medication, such an anti-depressant, they may help reduce pain.
  
  NSAIDs and acetaminophen (Tylenol) are most useful in treating the "ordinary" pains that accompany fibromyalgia—headaches and menstrual cramps, to name a few.
  
• Benzodiazepines, such as Xanax and Valium, relax muscles, improve sleep quality, and reduce symptoms of restless legs syndrome (commonly associated with fibromyalgia). While they may relieve some of your symptoms, benzodiazepines work by depressing the central nervous system and are addictive. A doctor's supervision is highly important if taking these medications.
  
• Non-narcotic analgesics, such as tramadol (Ultram), are stronger than acetaminophen but not as addictive as narcotics. They work in the brain to regulate pain perception.
  
• Opioid pain relievers, such as oxycodone (OxyContin), should only be used if all other options have been exhausted.

Medication Warning

Medications typically have side effects and other considerations that you should consider. Discuss all medications—even if they're over-the-counter and pose no apparent risk—with your doctor first.