Drugs for Fibromyalgia

Drugs for the Treatment of Fibromyalgia Symptoms:

Some specialist prescribes Antidepressants, like amitriptyline (Elavil) to treat symptoms of Fibromyalgia. Multiple symptoms may be affected by these medications such as depressed mood, pain, sleep disturbances and fatigue.

FDA has approved one of the Anticonvulsant drug named pregabalin (Lyrica) for Fibromyalgia treatment. Lyrica helps in reducing pain and it also helps in improving the daily basis functioning of some patients. Most often side effects caused by Lyrica include mild to moderate sleepiness and dizziness. Moreover, it can also cause weight gain and swelling. Keeping in view of these side effects FDA caution patients to take advise of their doctors about using Lyrica drug because it may also impair the ability of patient to drive which can be risky. Alternative anticonvulsants are also sometimes used by specialist to treat the disease.

FDA has also approved Duloxetine (Cymbalta), which is an antidepressant drug for fibromyalgia treatment. Cymbalta belongs to a category of drugs named as serotonin and nor epinephrine reuptake inhibitors (SNRIs). FDA has also approved Cymbalta for treatment of generalized anxiety disorders as well as diabetic nerve pain treatment in adults other than fibromyalgia and depression treatments. Side effects caused by this drug include dry mouth, nausea and constipation. Moreover, it may also cause dizziness and insomnia.

Another drug approved by FDA for Fibromyalgia treatment include Milnacipran (Savella) like Cymbalta, Savella also belongs to SNRIs. Mode of action of Savella is similar to other antidepressants but it is not used for the treatment of depression. When Savella is used by the patients of Fibromyalgia it helps in the pain reduction, improves patient’s physical function, and also brings about overall improvement of Fibromyalgia for some people. Commonly a side effect caused by Savella is nausea. Some other side effects of the drug include constipation, headache, insomnia and dizziness.

Medications that help in increasing restful sleep may also help in treating fibromyalgia symptoms. These medicines consist of low dose of antidepressants like amitriptyline taken before going to bed. Some other categories of sleeping pills are not usually considered significant for Fibromyalgia patients.

As there are little or no inflammation symptoms in Fibromyalgia patients so certain Anti-inflammatory drugs such as Naproxen and Ibuprofen are not considered helpful to treat the disease. However, these anti-inflammatory drugs may help in boosting pain relief from other Fibromyalgia medicines. Use of anti-inflammatory drugs results in many side effects, including bleeding, stomach upset and increased blood pressure.

One of the pain reliever namedAcetaminophen including Tylenol also seems to be helpful in treating Fibromyalgia. Acetaminophen (Tylenol) is also easier on the stomach and causes less drug interactions as compared to interactions caused by other anti inflammatory drugs. However, patient should strictly follow specialist prescription. Becauseover doses of Acetaminophen can results in liver problems.

To get relief of muscle pain caused due to Fibromyalgia certain muscle relaxants, including Cyclobenzaprine (Flexeril), is also taken by patients mostly at bedtime.

Use of Steroids like prednisone for treatment of Fibromyalgia associated inflammation doesn’t helped in improving or getting relief from Fibromyalgia symptoms.

However, when other therapies have failed then sometimes a strategy of directly injecting a steroid into muscles trigger point or muscle spasm is used to treat disease symptoms.

Cognitive Behavioral Therapy for Fibromyalgia:

Besides medication, certain other therapies including cognitive-behavioral therapy can aid patient in developing a sense of self control and also provide them awareness about their health condition. With the help of talk therapy, patient will be able to learn new strategies related to self management which will ultimately boosts up patient’s immune system and help patient in managing disease symptoms.

Effective Medicines for Fibromyalgia Treatment:

Different medications are used for the treatment of fibromyalgia symptoms including antidepressants, pain relievers, muscle relaxants and anticonvulsants which are described below:

Antidepressants:

Antidepressant is most often the first medicine that is prescribed by the doctor to fibromyalgia patient because it helps in relieving pain, sleep problems and fatigue. Furthermore it also help patient in managing depression, which is the common symptom of fibromyalgia patient. For many years certain antidepressants, named Tricyclics, have been used for treating fibromyalgia. Tricyclic antidepressants, such as nortriptyline (Pamelor) and amitriptyline, work by increasing the levels of neurotransmitters in the patient’s brain.

There are several other categories of antidepressants that have been proved to help in relieving the pain, sleeping problems and fatigue, in patients with fibromyalgia.

These include Milnacipran (Savella), Duloxetine (Cymbalta), and Venlafaxine (Effexor). Savella and Cymbalta are specifically approved by FDA to treat fibromyalgia. Furthermore there are also certain other antidepressants that have also been studied for fibromyalgia treatment which includes Paroetine (Paxil), Fluoxetine (Prozac) and Citalopram (Celexa).

Pain relievers:

To get relieve from deep muscle pain and trigger-point pain due to Fibromyalgia various types of pain relievers are sometimes recommended. These includeacetaminophen which works by increasing the pain threshold which will ultimately help patient in perceiving less pain. Furthermore, Non steroidal anti-inflammatory drugs (NSAIDs), when used in combination with other fibromyalgia medications, also help in treating disease symptoms.NSAIDsinclude ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve).

Muscle relaxants:

Cyclobenzaprine has proved to be useful muscle relaxant for the treatment of fibromyalgia. These drugs help patients by improving their sleep and also help them in ease of muscle tension. They produce their effects by acting in brain and ultimately help in muscles relaxation.

Anticonvulsants:

A new drug for treating fibromyalgia is Pregabalin (Lyrica), which was originally used to treat seizures. It works by affecting certain chemicals in the brain which are responsible to send pain signals across the patient’s nervous system. The effect is ultimately reduction in body pain, fatigue and improvement of sleep.

Another antiseizure medication named Gabapentin (Neurontin) seems to improve fibromyalgia symptoms as well.

Some other fibromyalgia pain medications:

Tramadol (Ultram) an important pain reliever may also be utilized by fibromyalgia patients. This medication is basically narcotic-like and it works by acting in the patient’s brain to influence the pain sensation. But it is not addictive as other narcotics.

In addition, specialist may also  prescribe Benzodiazepines includingAlprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan) and Clonazepam (Klonopin),to help relax  muscles pain, sleep improvement , and  also help in relieving symptoms of restless legs syndrome which is an unpleasant sensations felt in the legs that force Fibromyalgia patient to move them constantly. Benzodiazepines are addictive in nature and must be used with caution. Over dosage of drug can results in serious side effects.

If there is no relief and all alternate medications have been exhausted then certain powerful narcotic medications, such as Oxycodone (OxyContin), Hydrocodone (Lortab), Hydrocodone/acetaminophen (Vicodin), and Oxycodone/acetaminophen (Percocet) may be prescribed by doctors only in rare cases. However, these narcotics are highly addictive and must only be prescribed under strictly monitored medical supervision.

Cymbalta for Fibromyalgia Treatment:

Studies have shown that Cymbalta (duloxetine) which is an antidepressant has ability to cure some unique symptoms of the disease. It belongs to a class of medications named as serotonin and nor epinephrine reuptake inhibitors (SNRIs). Cymbalta was previously approved by FDA for the treatment of generalized anxiety disorder, depression and diabetic peripheral neuropathic pain.  Later on in June 2008 FDA approved Cymbalta for the treatment of fibromyalgia in adults. After that FDA has also approved another medication named c Savella (milnacipran), in 2009.

Cymbalta: Mechanism of action:

As fibromyalgia itself is a poorly understood disease, scientists are not sure about the mechanism of action of Cymbalta but they think that Fibromyalgia pain is caused due to nervous system changes that results in nerve cells firing too many signals along the pathways of pain and as a result the affected person become overly sensitive to external stimuli that is normally not perceived as painful.

Research studies have shown that Cymbalta may help in calming down these painful signals by elevating the level of nor epinephrine and serotonin in the brain which are naturally occurring neurotransmitters present in the brain. These neurotransmitters basically affects mood and it is believed that they also help in controlling the feeling of pain. SNRIs and Cymbalta work by blocking the re-entry of nor epinephrine and serotonin in the cells which results in elevation of their levels in the brain and ultimately this effect helps patient by improving mood and also helps in relieving Fibromyalgia pain.

 

Cymbalta Dosage:

Cymbalta is available in the form of capsule. The prescribed dose of medicine by the specialist is 60 mg/day. However during the first week the prescription is 30mg/day and it is then gradually increased to 60 mg/day. It should be strictly kept in mind while taking Cymbalta dose more than 60 mg/day because there is no evidence of improvement in patient’s pain with overdose. Infact this practice increase the chances of side effects.

If the medicine consumption is upsetting patient’s stomach it can be taken with some crackers or with meal. Patient should avoid drinking alcohol while taking medicine because it increases the risk of liver damage.

If in some cases recommended dose is missed by the patient then he/she should take it as soon as he/she remembers but it should not be taken close to the time of next dose because it can results in side effects. Patient should not double the dose because it will be harmful, in this scenario patient should skip the missed one and get back to the regular medication schedule. Furthermore, patient should not suddenly stop taking Cymbalta because it will results in unpleasant side effects such as headache and nausea. If a patient needs or wish to stop taking medicine then in this case he/she should take proper guideline by the doctor that how to reduce the medicine doze gradually overtime.

Cymbalta Benefits:

Clinical trials of Cymbalta proved to be significant because it readily improved pain symptoms in patients. More than half of the Fibromyalgia patients said that they felt much improved within one week of treatment. Pain relief is seen more in patients with existing depression; however patients without depression symptoms also felt greater improvement in Fibromyalgia symptoms.

Other Benefits of the Drug:

  • For at least 3 months of treatment pain is relieved significantly in patients. However treatment is based upon patient’s individual response.
  • Improvement in Fibromyalgia pain allows patient to get back to his/her daily routine.
  • Better sleep results in patient’s improved quality of life.
  • Patient’s muscles tissue will be healed with the help of more refreshing sleep.

SNRIs have seemed to produce fewer side effects in patients as compared to Tricyclic antidepressants which are also prescribed to treat Fibromyalgia.

Side Effects:

Most common side effects caused by Cymbalta are Dry mouth, Constipation and Nausea

Other side effects may include:Urinary hesitation, Drowsiness or sleepiness, Decreased appetite (may include anorexia), Increased sweating, Decreased sex drive, Jitters, nervousness, or restlessness (agitation).

Patient may feel dizziness upon standing when he/she has taken the first Cymbalta dose or when prescribed amount is increased. This effect is due to a drop in patient’s blood pressure, and is termed as orthostatic hypotension. Patient should monitor his/her blood pressure properly from time to time while Cymbalta he/she is on Cymbalta prescription.

Warnings and Risks:

Risk for suicidal behaviors and thoughts may increase in patients under age 24 when they are consuming Cymbalta and other antidepressants. Specialist willproperly monitor patient on Cymbalta prescription for unusual behavioral changes, worsening or newsymptoms of depression, or suicidal thoughts.

Cymbalta consumption may results in drop of sodium levels in the patient’sblood, which is potentially life-threatening state termed as hyponatremia. This complication is observed inolder adults;mostly those who consume diuretics or water pills. It then results inweakness, confusion and headaches, and in severe conditions it can lead to seizures, fainting, coma, and ultimately death of the patient.

Some patients consuming Cymbalta have also seemed to developliver problems and in rare cases, this condition will lead to liver failure and death of patient. Patient should immediately contact to his/her doctor if he/she develops any of these symptoms like Dark colored urine, Pain in the right upper belly area,Itching, Yellow skin or eyes (jaundice), Unexplained flu-like symptoms.

Cymbalta Drug Interactions:

In rare cases,patients who have taken Cymbalta develop a life-threatening condition termed asserotonin syndrome. This syndrome mostly results when patientis taking two or more medicines that are responsible to elevate the body’s serotonin levels. Human body needs serotonin for brain and nerve cells so that they can function properly, but too much level of Serotonin can be very dangerous. It can lead to rapid changes in muscle rigidity, blood pressure, seizures, and even it can cause patient’sdeath.

So before prescribing Cymbalta medicine to the patient, specialist should be aware that which medicines patient is already taking, including over-the-counter medicines, herbs and supplements as well.

Drugs that show interaction with Cymbalta medicine and can cause serotonin syndrome include:

Some other drugs that may also show interactions with Cymbalta are:

Doctor should be completely aware about the medical condition of the patient before prescribing Cymbalta and it should be prescribed with caution to patients who have:

Patients who should not consume Cymbalta:

Patientshould not take Cymbalta if he/she is already taking a medicine thioridazine, MAOI or have used it in the last 14 days, or suffering from uncontrolled narrow-angle glaucoma.

In animal studies Cymbalta have shown to cause adverse side effects on a developing fetus but no well-controlled studies of the drugs have been performed in breastfeedingor pregnantwomen. Women who are pregnant, breastfeeding, or scheduling to become pregnant should consult with their doctor about taking medicine. Patient should only take Cymbalta if the benefits of the drug are more than the associated risks.