Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

• 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)

Anti-seizure Medicines

• 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)

Tricyclic Antidepressants

• 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)

Selective Serotonin Reuptake Inhibitors (SSRIs)

• 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)

Muscle Relaxants

• 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

Central Nervous System Depressants

• 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

Opioids

• 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

Pain Relievers

• Acetaminophen

This medicine is used to ease pain.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• 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