Prescription Medications for Fibromyalgia: Lyrica, Cymbalta, Savella, and Off-Label Remedies


cymbalta-fibromyalgia
Cymbalta is an antidepressant that may help control fibromyalgia pain and fatigue.
In 2007, Pfizers Lyrica became the first prescription medication approved for the treatment of fibromyalgia. Since then, two more drugs—Cymbalta and Savella—have joined its ranks, expanding the options to treat this painful chronic condition.

But because so much is still unknown about what causes fibromyalgia, there is no go-to treatment. In fact, typically only “35% to 40% of patients will respond well to any one of these three drugs,” says Daniel Clauw, MD, the director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.

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Research suggests that people with fibromyalgia may have extremely sensitive central nervous systems that perceive pain much more acutely than those with normal pain responses. There is also some evidence that people who suffer from fibromyalgia experience a range of sleep disturbances that may leave them more prone to pain. An even newer theory is that fibromyalgia may be related to compression of the cervical spinal cord, which can lead to sleep disruptions as well as widespread pain.

The three drugs currently approved for fibromyalgia are thought to ease the pain by acting on either the nerves or brain chemicals called neurotransmitters. Since these drugs do not have a high success rate, patients often use more than one or try several before finding one that works well with the least side effects.

“People should be encouraged to find someone who is willing to work with them to find that combination or single treatment that works well,” says Charles E. Argoff, MD, a professor of neurology at Albany Medical College in New York.

You may find that over-the-counter medications help to alleviate some of the pain flare-ups associated with fibromyalgia. But if youve been diagnosed with the condition and are looking for long-term treatment, talk to a doctor about prescription drugs. Heres a brief breakdown of different medications used to treat fibro pain, both on- and off-label.

Lyrica
How it works: The first drug approved to treat fibromyalgia, Lyrica (pregabalin) is an anticonvulsant that the U.S. Food and Drug Administration (FDA) previously approved in late 2004 to treat pain associated with diabetic neuropathy and shingles. The medicine is believed to calm overactive neurons as well as possibly influence the release of neurotransmitters.

Recommended dosage: Begin at 150 mg daily, and can be increased to a maximum of 450 mg per day

When it may be prescribed: “Most of us think that if people have a prominent sleep disturbance, we should use Lyrica or Neurontin first,” says Dr. Clauw. Neurontin (gabapentin) is an anticonvulsant that has not been approved for, but is often used to treat, fibromyalgia.

What to consider: The most common side effects are dizziness, weight gain, fatigue, difficulty concentrating, and swelling in the hands and feet. In April 2009, the FDA also began requiring Lyrica to carry a warning that the drug increases the increase the risk of suicidal thoughts or behavior.


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Lead writer: Kate Rope
Last Updated: September 17, 2009

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