Prescription Medications For Treatment Of Fibromyalgia

As fibromyalgia has become widely recognized and more correctly diagnosed, demand for drug therapies that can be used to manage the symptoms of fibromyalgia has increased. In response, the pharmaceutical companies have worked to develop new medications or to expand the usage of existing medications to address the needs of the medical community and patients. The number of drugs that are specifically marketed or currently in clinical trials for fibromyalgia is limited, with only 3 currently recognized by the Federal Drug Administration (FDA), but other prescription medications can be very effective in treating symptoms.

FDA Approved Fibromyalgia Medications

Two of the most advertised drugs for the treatment of fibromyalgia as opposed to individual symptoms are the medications Lyrica ®.and Cymbalta®.. Lyrica®., also known as pregabalin, was approved by the FDA in 2007. This was the first drug to actually be approved to be marketed for fibromyalgia. One year lager Cymbalta ®.(duloxetine hydrochloride), also came on the market. Both medications were previously marketed to control other medical conditions with Lyrica ®.used to treat seizures and nerve pain known as diabetic peripheral neuropathy. Cymbalta®. was also previously approved and marketed to treat anxiety and depression.

Both medications have side effects for patients which can range from potentially non-existent to so severe that medication needs to be discontinued. Often people that try one and find side effects or limited effectiveness can switch medications and find a better result. The side effects of both medications can be difficult to deal with and may contribute to the severity of the fibromyalgia symptoms. For most doctors, Lyrica®. is the most commonly prescribed drug for fibromyalgia (21%) with Cymbalta seen as the second option with approximately 20% patients using this drug as their only prescription medication in the treatment of fibromyalgia symptoms.1

Lyrica®. side effects include the inability to sleep, dizziness, blurry vision, problems with concentration and focus, swelling of the hands and feet, weight gain and dry mouth. Some people may have allergic reactions to this medication. Cymbalta®. side effects include an increased sense of sleepiness, nausea, decreased appetite, suicidal thinking and behavior, increased sweating and constipation. Most individuals without depressive symptoms will not experience the potential risk of suicidal thoughts and behaviors while on Cymbalta®. but with depression a common concurrent condition this is a very serious consideration.

Savella®. (milnacipran) has been approved for use in Europe and now in the United States as well. This medication is similar to Cymbalta®. in that it is a serotonin and norepinephrine reuptake inhibitor, or SNRI, used to treat depression. This new FDA approved drug has side effects as well which are the same as those found with Cymbalta®. but may also include insomnia instead of sleepiness with an increase in blood pressure, heart rate and increased risk of vomiting.

Two other medications are currently in clinical trials and working through the FDA approval process. These include JZP-6 (sodium oxybate), also marketed as Xyrem®., and Effirma®. (oral flupertine). JZP-6 original application for approval was denied by the FDA due to several concerns about the limited number of clinical trials completed by the company. It is a central nervous system depressant that is often used in patients with cataplexy and narcolepsy and, as such is a Schedule III federally controlled substance. Effirma®. also is completing clinical trials in the USA and, like Savella®., has been approved and used in Europe for over 25 years for the treatment of pain.

It is important to note that patients using these medications do not experience complete control of their symptoms. It is noted in research studies that the patients report fewer symptoms than on the placebo used in the trials, but there are limits to what the patient’s can expect from these types of medications. 2

Other Prescription Medications

Even when taking a fibromyalgia drug, there may still be symptoms for which other prescription medications are required. It is essential for patients to work closely with their doctors in reporting any possible side effects to the medications and to follow all drug schedules correctly to avoid possible issues with drug interactions. Depending on the specific symptoms presented the following prescription drugs may be used to help to manage the symptoms of fibromyalgia and improve the overall quality of life for the individual.

Opiates and narcotics are not typically effective in controlling the symptoms of fibromyalgia, but different individuals may find various degrees of relief using these types of medications. Typically opiates and narcotics that are prescribed include Percocet®., Vicodin®. and OxyContin®.. There are significant concerns of addictions and abuse with the ongoing use of these drugs and patients and doctors must be aware of these issues.

Muscle relaxants such as cyclobenzapirine, may be used in combination with an antidepressant medication to assist in reducing muscle cramping, pain and discomfort. This medication combination is often effective for patients with depression and mild to moderate pain levels with occasional flares.

The other prescription medications used in the treatment of fibromyalgia are found within general categories of medications. These can include antidepressants such as SNRIs like Cymbalta®. or SSRIs which are selective serotonin reuptake inhibitors. Both of these can cause problems with sleep so may not be appropriate for all patients.  Tricyclic antidepressants are also used to help with pain relief and sleep and are generally well tolerated. Tricyclic antidepressants have been effectively used in the treatment of irritable bowel syndrome, which may be present in individuals with fibromyalgia or may have the same general pathway of development.

Working closely with your doctor and considering lifestyle, diet and exercise options to help manage fibromyalgia symptoms can also be instrumental in getting the most out of prescription medications.

References

1 Dussias, P., Kalali, A. H., & Staud, R. M. (2010). Treatment of Fibromyalgia. Psychiatry , 15-18.

2 Kim, L., Lipton, S., & Deodhar, A. (2009). Pregabalin for fibromyalgia: Some relief but no cure. Cleveland Clinic Journal of Medicine , 255-261.

3 Rahimi, R., Nikfar, S., Rezaie, A., & Abdollahi, M. (2009). Efficacy of tricyclic antidepressants in irritable bowel syndrome: A meta-analysis. World Journal of Gastroenterology , 1548-1553

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015

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