On June 21, 2007, Lyrica (pregabalin capsules CV) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. The approval of Lyrica was long-awaited because it's the first medicine that is FDA-approved to treat fibromyalgia. More fibromyalgia drugs are in development. Doctors also treat fibromyalgia with a variety of drugs developed and approved for other purposes. Below are some of the most commonly used categories of fibromyalgia medications. In 2008, Cymbalta was FDA-approved to treat fibromyalgia.
Analgesics are painkillers. They range from over-the-counter drugs, such as acetaminophen, to prescription drugs, such as tramadol, and even stronger narcotic drugs. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become dependent on them.
NSAIDs work by inhibiting prostaglandins, which play a role in pain and inflammation. These drugs, some of which are available over-the-counter, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.
Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine. Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia.
When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body's natural pain-killing substances called endorphins.
Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a SSRI. As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes:
SSRIs may be prescribed along with a tricyclic antidepressant. Doctors rarely prescribe SSRIs alone. Because they make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia.
Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) that is also showing promise.
Mixed Reuptake Inhibitors
Some newer antidepressants raise levels of both serotonin and norepinephrine, and are therefore called mixed reuptake inhibitors. Examples of these drugs include:
Researchers are actively studying the efficacy of these drugs in treating fibromyalgia.
Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include:
Other Medications For Fibromyalgia
Doctors may prescribe other medications, depending on a person's specific symptoms or fibromyalgia-related conditions. For example:
- Tegaserod and alosetron are FDA approved for the treatment of irritable bowel syndrome.
- Gabapentin is being studied as a treatment for fibromyalgia.
- Pregabalin (Lyrica) is the first medicine that is FDA-approved to treat fibromyalgia.
- Modafinil may help with fatigue.
- Sodium oxybate may help with excessive sleepiness.
Other symptom-specific drugs include:
- various headache remedies
- sleep aids such as:
- muscle relaxants
Source: NIH Publication NO. 04-5326