Fibromyalgia medications that are commonly prescribed include antidepressants (like amitriptyline or duloxetine), muscle relaxants (like cyclobenzaprine) and neuromodulators (like gabapentin). Some patients may also benefit from alternative therapies, like aroma therapy, psychotherapy and acupuncture. Physiotherapy that combined stretching and massage can also relieve pain and prevent flare-ups.
Treatment for fibromyalgia is individualized and is wholly guided the patient’s symptoms and experience. It is important to consult a rheumatologist or neurologist for diagnosis and treatment of this condition.
Medications for fibromyalgia that your doctor may prescribe include:
1. Antidepressants
Antidepressants are prescribed for the treatment of fibromyalgia as they direct directly on the brain to regulate substances that can affect pain management, such as serotonin, noradrenaline and dopamine. These medications can improve pain, fatigue and drowsiness as well as overall.
Some of the commonly prescribed antidepressants are:
- Amitriptyline: The initial recommended dose is 10 mg per day. It should be taken at night, 2 to 3 hours before going to bed.
- Nortriptyline: Like amitriptyline, the initial recommended dose is 10 mg per day, which can be gradually increased by the doctor as necessary. This capsule should be taken before going to bed.
- Duloxetine: Generally, the initial dose is 30 mg, which can be increased to a maximum of 60 mg as deemed necessary.
- Fluoxetine: To achieve therapeutic effect, fluoxetine should be prescribed in high doses, over 40 mg per day. The doctor will best assess and select the appropriate dosing.
- Moclobemide: The initial recommended dose is 300 mg per day, which is usually divided into 2 doses. This should be taken with meals. The maximum daily dose is 500 mg per day.
Antidepressant dosing is individualized to each patient’s case. It should be taken for at least 4 to 6 weeks to achieve therapeutic effect.
2. Muscle relaxants
Muscle relaxants are used to treat fibromyalgia because they decrease muscle rigidity. Muscles can become stiff with this condition, causing body aches and difficulty sleeping. Cyclobenzaprine is most commonly prescribed, with recommended doses varying from 1 to 4 mg per night. Treatment duration should last about 2 to 3 weeks.
3. Antiparkinson medications
Antiparkinson medication, like pramipexol, can help to treat tremors associated with Parkinson’s disease, but they can also reduce pain and improve sleep in patients with fibromyalgia. The initial recommended dose is 0.375 mg per day, which can be gradually increased to a maximum of 1.5 mg per day.
4. Analgesics
Common analgesics (like acetaminophen) and opioids (like tramadol) can be prescribed to reduce fibromyalgia-related pain These can be taken on their own or in combination to better address pain. Doses, frequency and duration of treatment should be prescribed by a doctor.
5. Gabapentinoids
Gabapentinoids act directly on the nervous system to regulate nerve pathways that regulate pain. Examples include:
- Gabapentin: These should be taken orally, with the initial dose of 300 mg per day. This can be increased to a maximum of 900 to 3600 mg per day.
- Pregabalin: The initial dose is 75 mg orally, twice per day (or 150 mg per day), which can be gradually increased to a maximum of 450 mg per day, also divided into 2 doses. Read more about how pregabalin is prescribed and how to take it.
Gabapentin and pregabalin can be taken before or after meals, and can only be obtained with a prescription. Your first dose should be taken at night, before going to bed.
6. Hypnotics
Sleep disturbances are commonly reported by patients with fibromyalgia, causing insomnia and non-restorative sleep patterns. Generally, hypnotics can help to address sleep issues, with some options including:
- Zopiclone: The maximum recommended dose is 7.5mg per day, taken orally at night. Treatment should not last for longer than 4 weeks, as it can lead to dependency.
- Zolpidem: The maximum recommended dose is 10mg per day, taken orally at night. Treatment duration should be as short as possible, and should not go over 4 weeks. Read more about the side effects associated with zolpidem use.
Hypnotics can also help to decrease muscular tension, which interferes with good sleep.
7. Anxiolytics
Anxiolytics are medications that work to decrease anxiety, promote muscle relaxaiton and induce drowsiness, all which can improve quality of life in people with fibromyalgia. Anxiolytics should be taken for a short term course, as they can lead to dependency. Some examples include:
- Lorazepam: These work for 10 to 20 hours, and should be taken as a single daily dose of 1 to 2 mg (usually before going to bed)
- Diazepam: The effect of diazepam lasts for longer (44 to 48 hours). It should be taken as a single recommended dose of one 5 to 10 mg once per day, at night. This can be adjusted as per the doctor’s evaluation.
Treatment for anxiolytics should be started at the lowest possible dose. These medications should not be used for longer than 2 to 3 months.
