FDA-approved medications and more
A variety of medications may treat your fibromyalgia 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 antidepressants to improve your mood. Based on your specific symptoms, your doctor will develop the right medication regimen for you.
Medications may make up only a part of your fibromyalgia treatment plan. To learn about other ways to reduce your chronic fibromyalgia pain, read our article about all fibromyalgia treatments.
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 antidepressants. 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.
Antidepressants for Fibromyalgia
In many cases, antidepressants are used as a first line of defense in fibromyalgia treatment. Doctors usually prescribe one or a combination of antidepressants from three classes—tricyclic anti-depressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs).
- Tricyclic antidepressants: 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 antidepressants.
- SNRIs: This class of antidepressants 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 antidepressants, 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 antidepressant to prevent sleep disturbances. Fluoxetine hydrochloride (Prozac) and sertraline hydrochloride (Zoloft) are SSRIs.
Anti-Epileptics: Another Fibromyalgia Medication Option
Lyrica is an anti-epileptic (or anti-convulsant) that also happens to be the first FDA-approved drug to specifically treat fibromyalgia.
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.
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 Fibromyalgia Medications
- Over-the-counter options: nonsteroidal 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 antidepressant, 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 are stronger than acetaminophen but not as addictive as narcotics. They work in the brain to regulate pain perception.
- Opioid pain relievers, should only be used if all other options have been exhausted.
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. That way, he or she will be better able to treat your fibromyalgia.