Fibromyalgia Medications
Possibly the most useful medications for fibromyalgia are several antidepressants.
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. Doctors prescribe several
types of antidepressants for people with fibromyalgia, described below.
Doctors treat fibromyalgia with a variety of medications developed
and approved for other purposes.
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Antidepressants
- Tricyclic 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 tricyclic
medications used to treat fibromyalgia include amitriptyline hydrochloride
(Elavil, Endep), cyclobenzaprine (Cycloflex, Flexeril, Flexiban),
doxepin (Adapin, Sinequan), and nortriptyline (Aventyl, Pamelor).
Both amitriptyline and cyclobenzaprine have been proved useful for
the treatment of fibromyalgia.
- Mixed reuptake inhibitors—Some newer antidepressants raise levels
of both serotonin and norepinephrine, and are therefore called mixed
reuptake inhibitors. Examples of these medications include venlafaxine
(Effexor) and nefazadone (Serzone). Researchers are actively studying
the efficacy of these newer medications in treating fibromyalgia.
- Selective serotonin reuptake inhibitors—If a tricyclic antidepressant
fails to bring relief, doctors sometimes prescribe a newer type of
antidepressant called a selective serotonin reuptake inhibitor (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 fluoxetine (Prozac), paroxetine (Paxil), and sertraline
(Zoloft). 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. Studies have shown that a
combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine
resulted in greater improvements in the study participants' fibromyalgia
symptoms than either drug alone.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen
(Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat
inflammation. Although inflammation is not a symptom of fibromyalgia,
NSAIDs also relieve pain. The drugs work by inhibiting substances in
the body called prostaglandins, which play a role in pain and inflammation.
These medications, some of which are available without a prescription,
may help ease the muscle aches of fibromyalgia. They may also relieve
menstrual cramps and the headaches often associated with fibromyalgia.
Analgesics
Analgesics range from over-the-counter acetaminophen (Tylenol) to prescription
medicines, and even stronger narcotic preparations. 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 physically or psychologically
dependent on them.
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