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

Anti-seizure medicines:

  • Gabapentin
  • Pregabalin

Selective Serotonin-reuptake Inhibitors (SSRIs):

  • Fluoxetine
  • Sertraline
  • Paroxetine
  • Fluvoxamine
  • Citalopram

Tricyclic antidepressants:

  • Amitriptyline
  • Desipramine
  • Doxepin
  • Imipramine
  • Trazodone
  • Nortriptyline

Muscle Relaxants:

  • Cyclobenzaprine

Central Nervous System Depressants:

  • Zolpidem
  • Zaleplon
  • Sodium oxybate

Opioids:

  • Morphine
  • Oxycodon
  • Hydrocodone
  • Hydromorphone
  • Meperidine
  • Tramadol

Over-the-Counter Medications

Pain Relievers:

  • Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):

  • Aspirin
  • Ibuprofen
  • Naproxen

Prescription Medications

 

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

Over-the-Counter Medications

 

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:
  • 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_Info/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.

Last reviewed March 2020 by EBSCO Medical Review Board James P. Cornell, MD  Last Updated: 3/5/2021