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Medications for Fibromyalgia

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions.

Your doctor may prescribe one or more of the following medications to help treat your fibromyalgia symptoms.

Prescription Medications

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

  • Milnacipran
  • Duloxetine

Anticonvulsants

  • Gabapentin
  • Pregabalin

Tricyclic antidepressants

  • Amitriptyline
  • Desipramine
  • Doxepin
  • Imipramine
  • Trazodone
  • Nortriptyline

Selective Serotonin-reuptake Inhibitors (SSRIs)

  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Fluvoxamine
  • Citalopram

Muscle Relaxants

  • Cyclobenzaprine

Central Nervous System Depressants

  • Zolpidem
  • Zaleplon
  • Sodium oxybate

Opioids

  • Morphine
  • Oxycodon
  • Hydrocodone
  • Hydromorphone
  • Meperidine
  • Tramadol

Over-the-Counter Medications

Pain Relievers

  • Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • Aspirin
  • Ibuprofen
  • Naproxen

Prescription Medications

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
  • Milnacipran
  • Duloxetine

SNRIs are a type of antidepressant medication that works by increasing the brain's levels of serotonin and norepinephrine (types of neurotransmitters). Milnacipran and Duloxetine may reduce fibromyalgia pain. They are both U.S. Food and Drug Administration (FDA) approved to treat fibromyalgia.

Possible side effects include:

  • Headache
  • Nausea and vomiting
  • Constipation
  • Insomnia
  • Flushing
  • Lightheadedness
  • Sleepiness
  • Blurry vision
  • Changes in thinking
  • Nervousness
  • Diarrhea
  • Dry mouth (Duloxetine)
  • Decreased sexual drive or ability
  • Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)
Anticonvulsants
  • Pregabalin
  • Gabapentin

Anticonvulsant medications, like Pregabalin and Gabapentin, may be prescribed to reduce fibromyalgia symptoms, like pain and sleep problems. However, only Pregabalin is approved by the FDA to treat fibromyalgia.

Possible side effects include:

  • Lightheadedness
  • Fatigue
  • Blurry vision
  • Changes in thinking
  • Change in balance
  • Weight gain
  • Muscle pain
  • Headache
  • Shakiness
  • Dry mouth
  • Emotional difficulties
  • Nausea and vomiting
  • Back or joint pain (taking Gabapentin)
  • Constipation (taking Gabapentin)
Tricyclic Antidepressants
  • Amitriptyline
  • Desipramine
  • Doxepin
  • Imipramine
  • Trazodone
  • Nortriptyline

Tricyclics are a class of antidepressants that may help relieve depression. They may also help improve sleep and decrease muscle pain.

Possible side effects include:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Decreased sexual drive or ability
  • Weight gain
  • Difficulty urinating
  • Heart rhythm disturbances
  • Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)
Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Fluvoxamine
  • Citalopram

SSRIs increase levels of serotonin, a brain chemical that is associated with a sense of well-being. SSRIs may help improve fibromyalgia symptoms.

Possible side effects include:

  • Decreased sexual drive or ability
  • Restlessness
  • Nausea
  • Headache
  • Loss of appetite
  • Weight loss
  • Weight gain
  • Insomnia
  • Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)
Muscle Relaxants
  • Cyclobenzaprine

Muscle relaxants decrease muscle tone. Decreased muscle tone helps relieve symptoms by reducing muscle spasms, pain, and twitching. This drug is not recommended in elderly adults.

Possible side effects include:

  • Impaired alertness and coordination that may be worse when combined with alcohol or other central nervous system depressants
  • Drowsiness
  • Dry mouth
  • Lightheadedness
  • Fatigue
  • Headache
Central Nervous System Depressants
  • Zolpidem
  • Zaleplon
  • Sodium oxybate

A common symptom of fibromyalgia is insomnia. Your doctor may prescribe a sleep medication, or hypnotic, such as Zolpidem or Zaleplon. Hypnotics are central nervous system depressants. They slow the nervous system by increasing the activity of a brain chemical that blocks neuron excitability.

It is best to use these medications only for brief periods of time. With longer use, you may become dependent on them. They should not be relied on for the long-term management of insomnia. Possible side effects include:

  • Clumsiness or unsteadiness
  • Lightheadedness
  • Slurred speech
  • Nightmares
  • Agitation
  • Memory loss
  • Dependency
  • Sedation, drowsiness, and daytime sleepiness

Sodium oxybate is another central nervous system depressant. This medication may help improve symptoms of fibromyalgia. Possible side effects include:

  • Lightheadedness
  • Blurred vision
  • Inability to think clearly
  • Headache
  • Nausea and vomiting
  • Dependency—This medication can lead to addiction. Your doctor will need to closely monitor you.
Opioids
  • Morphine
  • Oxycodone
  • Hydrocodone
  • Hydromorphone
  • Meperidine
  • Tramadol

Opioids should only be used when all other pain management approaches have failed. They work by attaching to specific receptors in the body called opioid receptors. These receptors are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to the receptors, they block the transmission of pain messages to the brain. Opioids can also induce a feeling of euphoria, by stimulating regions of the brain that mediate pleasure sensations. Tramadol should not be used in people with a history of seizures or epilepsy.

Some opioids may contain acetaminophen. Read the ingredient list on medication labels. High doses of acetaminophen can increase the risk of liver damage. Check the ingredient list of all your medications to make sure you are not taking too much acetaminophen.

Possible side effects include:

  • Feeling lightheaded, sleepy, having blurred vision, or a change in thinking clearly
  • Nausea or vomiting
  • Constipation
  • Itching
  • Dry mouth
  • Seizures (Tramadol)
  • Dependency—This medication can lead to addiction. Your doctor will need to closely monitor you.

Over-the-Counter Medications

Pain Relievers
  • Acetaminophen

Acetaminophen is used to relieve pain. Unlike aspirin products, acetaminophen rarely causes stomach irritation or bleeding. However, people with liver disease or heavy alcohol consumption should avoid these drugs. Get your doctor's approval before using acetaminophen for more than a short time.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • Aspirin
  • Ibuprofen
  • Naproxen

NSAIDs are used to relieve symptoms, such as inflammation, swelling, stiffness, and pain. Since they may cause side effects, get your doctor's approval before using them for more than a short time.

Possible side effects include:

  • Stomach problems, including:
  • Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease
  • Kidney damage
  • Liver inflammation
  • Lightheadedness
  • Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes
  • Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect. Report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

Revision Information

  • Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273. Updated August 12, 2010. Accessed August 8, 2013.

  • Buckhardt CS, Goldenberg D, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview (IL): American Pain Society (APS); 2005, as summarized in National Guideline Clearinghouse. 2005;19:7298.

  • Cyclobenzaprine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated January 18, 2013. Accessed August 8, 2012.

  • Duloxetine. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated April 4, 2013. Accessed August 8, 2012.

  • Fibromyalgia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated July 15, 2013. Accessed August 8, 2013.

  • Gabapentin. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated August 2, 2013. Accessed August 8, 2012.

  • Milnacipran. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated January 18, 2013. Accessed August 8, 2012.

  • Pregabalin. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated June 17, 2013. Accessed August 8, 2012.

  • Sodium oxybate. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated July 12, 2013. Accessed August 8, 2012.

  • Tramadol. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated January 18, 2013. Accessed August 8, 2012.

  • 2/17/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Russell IJ, Perkins AT, et al. Oxybate SXB-26 Fibromyalgia Syndrome Study Group. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Arthritis Rheum. 2009;60:299-309.

  • 7/30/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Häuser W, Petzke F, et al. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J Pain. 2010;11(6):505-521.

  • 8/6/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Häuser W, Petzke F, et al. Comparative efficacy and harms of duloxetine, milnacipran, and pregabalin in fibromyalgia syndrome. J Pain. 2010;11(6):505-521.

  • 11/30/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: US Food and Drug Administration. Propoxyphene: withdrawal—risk of cardiac toxicity. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm234389.htm. Published November 19, 2010. Accessed August 8, 2013.

  • 2/18/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.