Here are the basics about each of the medicines below. Only common problems with them are listed.
Prescription Medications
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
- Milnacipran
- Duloxetine
- Gabapentin
- Pregabalin
Selective Serotonin-reuptake Inhibitors (SSRIs):
- Fluoxetine
- Sertraline
- Paroxetine
- Fluvoxamine
- Citalopram
- Amitriptyline
- Desipramine
- Doxepin
- Imipramine
- Trazodone
- Nortriptyline
- Cyclobenzaprine
Central Nervous System Depressants:
- Zolpidem
- Zaleplon
- Sodium oxybate
- Morphine
- Oxycodon
- Hydrocodone
- Hydromorphone
- Meperidine
- Tramadol
Over-the-Counter Medications
- Acetaminophen
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
- Aspirin
- Ibuprofen
- Naproxen
Prescription Medications
- Milnacipran
- Duloxetine
SNRIs are antidepressants that work by raising the brain's levels of serotonin and norepinephrine (types of neurotransmitters). These may ease pain.
Some problems may be:
- Headache
- Nausea and vomiting
- Constipation
- Insomnia
- Flushing
- Lightheadedness
- Sleepiness
- Blurred eyesight
- Changes in thinking
- Nervousness
- Diarrhea
- Dry mouth (duloxetine)
- Problems with sex drive and ability
- Mood and behavior changes, such as suicidal thoughts (young adults may be at higher risk)
- Pregabalin
- Gabapentin
These anti-seizure medicines may be given to manage problems like pain and sleep problems. Only pregabalin is approved by the FDA to treat fibromyalgia.
Some problems may be:
- Lightheadedness
- Fatigue
- Blurred eyesight
- Changes in thinking
- Change in balance
- Weight gain
- Muscle pain
- Headache
- Shakiness
- Dry mouth
- Emotional problems
- Nausea and vomiting
- Back or joint pain (gabapentin)
- Constipation (gabapentin)
- Amitriptyline
- Desipramine
- Doxepin
- Imipramine
- Trazodone
- Nortriptyline
Tricyclics are a class of antidepressants that may help ease depression. They may also help improve sleep and ease muscle pain by changing brain chemistry.
Some problems may be:
- Dry mouth
- Blurred eyesight
- Constipation
- Problems with sex drive or function
- Weight gain
- Problems urinating
- Heart rhythm disturbances
- Mood and behavior changes, such as suicidal thoughts (young adults may be at higher risk)
- Fluoxetine
- Sertraline
- Paroxetine
- Fluvoxamine
- Citalopram
SSRIs raise levels of serotonin, a brain chemical that is linked to a sense of well-being. SSRIs may ease symptoms.
Some problems may be:
- Problems with sex drive or function
- Restlessness
- Nausea
- Headache
- Lack of hunger
- Weight loss or gain
- Insomnia
- Mood and behavior changes, such as suicidal thoughts (young adults may be at higher risk)
- Cyclobenzaprine
Muscle relaxants decrease muscle tone. This helps ease muscle spasms, pain, and twitching.
Some problems may be:
- Alertness and coordination problems that may be worse when taken with alcohol or other central nervous system depressants
- Drowsiness
- Dry mouth
- Lightheadedness
- Fatigue
- Headache
- Zolpidem
- Zaleplon
- Sodium oxybate
Many people with fibromyalgia have insomnia. Sleep medicine or a hypnotic, such as zolpidem or zaleplon, may be taken.
These medicines should only be taken for a short time. Longer use may cause dependence. Some problems may be:
- Clumsiness or unsteadiness
- Lightheadedness
- Slurred speech
- Nightmares
- Nervousness
- Memory loss
- Tiredness, drowsiness, and daytime sleepiness
Sodium oxybate is another central nervous system depressant. It may help improve symptoms. Some problems may be:
- Lightheadedness
- Blurred eyesight
- Problems with focus
- Headache
- Nausea and vomiting
- Dependence
- Morphine
- Oxycodone
- Hydrocodone
- Hydromorphone
- Meperidine
- Tramadol
Opioids should only be used when other methods have not helped. They work by blocking pain messages to the brain.
Some problems may be:
- Lightheadedness
- Drowsiness
- Blurred eyesight
- Problems with focus
- Nausea or vomiting
- Constipation
- Itching
- Dry mouth
- Seizures (tramadol)
- Dependence
Over-the-Counter Medications
- Aspirin
- Ibuprofen
- Naproxen
NSAIDs are used to ease swelling, stiffness, and pain. They should only be used for a short time.
Some problems may be:
-
Stomach problems, such as:
- Stomach upset
- Stomach ulcers and bleeding
- Worsening of health problems, such as high blood pressure, heart failure, or kidney disease
- Kidney damage
- Liver inflammation
- Lightheadedness
- Severe allergic reaction, such as hives, problems breathing, or swelling around the eyes
- Increased risk of bleeding
References
Fibromyalgia. American College of Rheumatology website. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia. Accessed August 11, 2020.
Fibromyalgia. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/fibromyalgia . Accessed August 11, 2020.
Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Fibromyalgia/default.asp. Accessed August 11, 2020.
Macfarlane GJ, Kronisch C, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017 Feb;76(2):318-328.
Revision Information
- Reviewer: EBSCO Medical Review Board James P. Cornell, MD
- Review Date: 03/2020
- Update Date: 03/05/2021