There are several treatment options for a person diagnosed with fibromyalgia. One treatment option is medication. At present, only one medication (Lyrica®) has been approved by the U.S. Food and Drug Administration (FDA) specifically for treating fibromyalgia. Healthcare providers may also treat fibromyalgia with a variety of medications developed and approved for other purposes. Using these medicines for the treatment of fibromyalgia is known as using them for an “off-label” purpose. While these drugs have not been licensed to treat fibromyalgia, a number of studies have shown how they can provide benefits to people with the condition.
The following are some of the most commonly used categories of medications for fibromyalgia:
- Pain relievers (analgesics)
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Antiseizure medicines
- A select group of other medications used to treat specific symptoms.
Lyrica as a Fibromyalgia Medication
In June 2007, pregabalin (Lyrica®) was approved by the FDA for treating fibromyalgia in adults. Lyrica was already approved to treat seizures, as well as pain from damaged nerves that can happen in people with diabetes (diabetic neuropathy) and in those who develop pain (postherpetic neuralgia) following the shingles rash.
In previous clinical studies, Lyrica was shown to reduce pain and improve daily functions in some people with fibromyalgia. These studies also demonstrated that fibromyalgia symptoms worsened when Lyrica was withdrawn.
Some of the most common Lyrica side effects include dizziness and sleepiness, blurry vision, weight gain, trouble concentrating, swelling of the hands and feet, and a dry mouth. Allergic reactions can also occur. These are rare, but potentially serious.
Pain Relievers Used as Fibromyalgia Medication
Analgesics are pain relievers. They range from over-the-counter acetaminophen (Tylenol®) or aspirin to prescription medicines, such as tramadol (Ultram®).
For some 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 healthcare providers hesitate to prescribe them for long-term use because of the potential for physical or psychological addiction to the drugs.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs represent another class of fibromyalgia medications that are sometimes useful against pain. However, these medicines tend to work better when combined with other medications.
There are many NSAIDs that may be recommended. Some are available over the counter (for example, Advil®, Motrin®, Aleve®, and ketoprofen). Other NSAIDs require a prescription. They may be used to help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.
Some examples of NSAIDs that can be used to treat fibromyalgia include:
- Ibuprofen (Motrin®, Advil®)
- Naproxen (Naprosyn®) or naproxen sodium (Aleve®, Anaprox®, Naprelan®)
- Celecoxib (Celebrex®)
- Indomethacin (Indocin®)
- Diclofenac (Voltaren®, Cataflam®)
- Etodolac (Lodine®, Lodine® XL)
- Meloxicam (Mobic®)
- Nabumetone (Relafen®)
- Oxaprozin (Daypro®)
- Many others.
Some of the most common NSAIDs side effects include:
- Abdominal pain (or stomach pain)
- An unexplained rash.
There are also certain groups of people who may be at a higher risk of side effects while taking NSAIDs (such as those with heart disease or stomach ulcers). These people should take NSAIDs with caution or not at all.
Perhaps the most useful fibromyalgia medications include several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine (which was formerly called adrenaline). 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. Healthcare providers prescribe several types of antidepressants as fibromyalgia medications, including:
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors (SSRIs), or
- Other antidepressants.
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 tricyclics used as fibromyalgia medications include:
- Amitriptyline (Elavil®)
- Doxepin (Sinequan®)
- Nortriptyline (Pamelor®)
- Desipramine (Norpramin®)
- Maprotiline (Ludiomil®)
- Imipramine (Tofranil®).
If a tricyclic antidepressant fails to bring relief, a healthcare provider will sometimes prescribe a newer type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). As with tricyclics, healthcare providers 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.
Some examples of SSRIs used as fibromyalgia medications include:
- Fluoxetine (Prozac®)
- Sertraline (Zoloft®)
- Citalopram (Celexa®)
- Escitalopram (Lexapro®)
- Fluvoxamine (Luvox®)
- Paroxetine (Paxil®, Paxil CR®)
- Sertraline (Zoloft®).
SSRIs may be prescribed along with a tricyclic antidepressant. Healthcare providers rarely prescribe SSRIs alone. Since SSRIs make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia. In previous studies, a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants’ fibromyalgia symptoms than when either drug was used alone.
Some newer antidepressants raise levels of different chemicals in the brain, such as serotonin and norepinephrine. Some examples of these antidepressants that may be used to treat fibromyalgia symptoms include:
BenzodiazepinesBenzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. These medicines can also relieve the symptoms of restless legs syndrome (RLS), 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, healthcare providers usually prescribe benzodiazepines only for people who have not responded to other therapies. Some examples of benzodiazepines used as fibromyalgia medications include:
- Clonazepam (Klonopin®)
- Diazepam (Valium®)
- Lorazepam (Ativan®).
Antiseizure MedicinesAntiseizure medications (also known as anticonvulsants or seizure medicines) are helpful in treating pain, particularly neuropathic pain. Many people with fibromyalgia have burning or electrical shock feelings in their hands and feet. Seizure medicines have been helpful in improving these symptoms.
Besides Lyrica (which is approved to treat fibromyalgia symptoms), some examples of seizure medicines used off-label include:
Other Fibromyalgia Medications
In addition to the general categories of drugs described above, healthcare providers may prescribe other drugs, depending on a person’s specific symptoms or fibromyalgia-related conditions. For example, in recent years, alosetron (Lotronex®) has been approved by the FDA for the treatment of irritable bowel syndrome (which is common in people with fibromyalgia). Some other symptom-specific medications include:
- Sleep medications, such as:
- Eszopiclone (Lunesta®)
- Zolpidem (Ambien®, Ambien CR®)
- Zaleplon (Sonata®)
- Ramelteon (Rozerem®)
- Muscle relaxants, such as cyclobenzaprine (Flexeril®)
- Restless legs syndrome medications, such as ropinirole (Requip®)
- Headache medicines.