FDA approved treatment for Fibromyalgia

FDA approved treatment for Fibromyalgia

What medications are Food and Drug Administration (FDA)-approved for treatment of Fibromyalgia? How do you choose which one to use?

Three medications are FDA-approved for treatment of FM:

  • • Dual reuptake inhibitors (serotonin-norepinephrine reuptake inhibitors [SNRI]): increase serotonin and norepinephrine at synapses in the descending analgesia pathways.
    • Duloxetine (Cymbalta): start 20 to 30 mg in the morning with food. Titrate monthly to 60 mg/day or effect.
    • Milnacipran (Savella): start 12.5 mg in the morning with food. Increase by 12.5 mg every 3 to 7 days to effect. Typical dose: 50 mg twice a day (BID; doses of 100 mg BID have been described).
  • • Anticonvulsant (α2-δ ligands): bind to ligand on voltage-gated calcium channels letting less calcium in, which decreases the release of excitatory neurotransmitters (glutamate, substance P).
    • Pregabalin (Lyrica): start 50 mg with food before bed. After 1 week, increase to 50 mg BID and titrate dose to effect. Typical dose: 75 to 150 mg BID (max dose 225 mg BID).

One of these three may be more beneficial than the others depending on the associated FM-related symptoms:

  • • Duloxetine: use in FM patients with depressed mood and fatigue or osteoarthritis of the back and knees
  • • Milnacipran: use in FM patients with cognitive dysfunction (fibrofog) and fatigue
  • • Pregabalin: use in FM patients with profound sleep disturbance and/or neuropathic pain symptoms.

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