#6 Mt. Sinai Standard Therapys for Fibromyalgia

Medications for Fibromyalgia

by Michelle Badash, MS

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, so ask your healthcare provider if you need to take any special precautions. Use each of these medications only as recommended by your healthcare provider, and according to the instructions  provided. If you have further questions about usage or side effects, contact your  healthcare provider.  Your doctor may  prescribe one or more of the following medications to help treat your fibromyalgia symptoms

Prescription Medications 
Tricyclics antidepressants
Amitriptyline (Elavil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Trazodone (Desyrel)
Nortriptyline (Pamelor)

Selective Serotonin-reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Citalopram (Celexa)

Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians,  patients, families and caregivers of patients with depression to closely  monitor both adults and children receiving certain antidepressant medications. The  FDA is concerned about the possibility of worsening depression and/or the  emergence of suicidal thoughts, especially among children and adolescents at the  beginning of treatment, or when there’s an increase or decrease in the  dose. The medications of concern—mostly SSRIs (Selective Serotonin  Reuptake Inhibitors)—are: Prozac (fluoxetine), Zoloft  (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram); Lexapro  (escitalopram), Wellbutrin
 (bupropion), Effexor (venlafaxine), Serzone (nefazodone),  and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is  approved for use in children and adolescents for the treatment of major  depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine)  are approved for use in children and adolescents for the treatment of obsessive  compulsive disorder.
For more information, please visit http://www.fda.gov/cder/drug/antidepressants. 

(THEY WILL KILL YOU !!!)

Sleep medications

Zolpidem (Ambien)
Zaleplon (Sonata)

Opioids
Morphine
Oxycodone (OxyContin)
Propoxyphene (Darvon)
Hydrocodone (Vicodin, Percocet)
Hydromorphone (Dilaudid)
Meperidine (Demerol)

Over-the-Counter Medications

Pain Relievers
Acetaminophen (Aceta, Apacet, Feverall, Panadol,
Tylenol) Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aspirin
Ibuprofen (Advil, Genpril, Ibuprin, Motrin, Nuprin,
Rufen) Naproxen (Aleve)

Prescription Medications
Tricyclic Antidepressants
Amitriptyline (Elavil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Trazodone (Desyrel)
Nortriptyline (Pamelor)
Tricyclics are a class of antidepressants that may help relieve depression.At lower doses, they may help improve sleep and decrease muscle pain.

Possible side effects include

Dry mouth
Blurred vision
Constipation
Sexual dysfunction
Weight gain
Difficulty in urinating
Disturbances in heart rhythm
Selective Serotonin-reuptake Inhibitors (SSRIs) ***see note above
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Citalopram (Celexa)
SSRIs increase levels of serotonin, a brain chemical that is associated with a sense of well-being. Serotonin may be decreased in some people with fibromyalgia.

Possible side effects include:
Decreased sexual drive or ability
Restlessness
Nausea
Headache
Insomnia

Sleep Medications
Zolpidem (Ambien)
Zaleplon (Sonata)
Since a common symptom of fibromyalgia is insomnia, your doctor may prescribe a sleep medication, or hypnotic, to improve your sleep. 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 hypnotic medications only for brief periods of time,because 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
Dizziness or lightheadedness
Slurred speech
Nightmares
Agitation
Memory loss
Dependency
Sedation, drowsiness and daytime sleepiness

Opioids
Morphine
Oxycodone (OxyContin)
Propoxyphene (Darvon)
Hydrocodone (Vicodin, Percocet)
Hydromorphone (Dilaudid)
Meperidine (Demerol)

Opioids are sometimes prescribed for severe pain. They work by attaching to specific receptors in the body called opioid receptors. These receptors arefound in the brain, spinal cord, and gastrointestinal tract. When these drugsattach 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. Opioids can cause sedation and addiction–their use needs to be carefullymonitored by a physician.

Over-the-Counter Medications
Analgesics (Pain Relievers) Acetaminophen (Aceta, Apacet, Feverall, Panadol,Tylenol)

Acetaminophen is used to relieve pain. Unlike aspirin products,acetaminophen rarely causes stomach irritation or bleeding. However, peoplewith liver disease or heavy alcohol consumption should avoid these drugs. Get your doctor's approval before using acetaminophen for more than a short time. Do not combine acetaminophen with a monoamine oxidase inhibitor (used for depression, emotional conditions, or Parkinson's disease). Ask a doctor beforeuse if you are taking sedatives or tranquilizers.

Nonsteroidal Anti-inflammatory Drug (NSAIDs)
Aspirin
Ibuprofen (Advil, Genpril, Ibuprin, Motrin, Nuprin,Rufen)
Naproxen (Aleve)
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:
Abdominal or stomach cramps, pain, or discomfort (mild to moderate)
Diarrhea
Dizziness, drowsiness, or lightheadedness
Headache (mild to moderate)
Heartburn, indigestion, nausea, or vomiting
Allergic reaction with hives, swelling, or shock
Asthma or shortness of breath
High blood pressure or kidney problems Stomach irritation, ulcers, or bleeding Increased tendency to bleed 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
healthcare provider.Don t share them with anyone else. Know what effects and side
effects to expect, and report them to your healthcare provider. 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.

REFERENCES:
Fibromyalgia Network website. Available at: http://www.fmnetnews.com/.
USP DI 2001, 21st ed. Micromedex; 2001.
Last reviewed October 2005 by Robert

Leach, MD