Common Medications given
for the treatment of Fibromyalgia
Risks and Side effects
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It is a given, that nearly all medicines have side effects. However, it pays to know what most of them are. So, to be aware of the possible side effects and risks related to medications you may be given. Here is a listing of the most commonly prescribed in FM, their risks and side effects.

( Now the reason I focus on their side effects and other bad reactions, is that most doctors and pharmacies will tell you what the medication is used for, and when to take it, with or without food etc ... but seldom will they tell you all of the other possible effects it may have, that said.. onward :)


One of the most common medications given for FM are Non steroidal anti-inflammatory drugs (NSAIDs), whose use has been proved to be ineffective ( Research ) in FM, as FM is not considered an inflammatory condition. Furthermore, research shows that to use such medications on a daily basis is to put ones self at risk. These risk factors are much lessened, in short term use for acute states.

"Non steroidal anti-inflammatory drugs (NSAIDs) are typically used to treat pain and swelling (inflammation) associated with medical conditions like arthritis. A few examples of these medications are aspirin, ibuprofen and naproxen.

More than 14 million Americans take NSAIDs every day. Each year, NSAID use results in approximately 16,500 deaths and 103,000 hospitalizations in the United States. Continual use of NSAIDs may increase the risk of developing a stomach ulcer or liver damage. "

"Renal risks of nonselective NSAIDS: At least 8 case-control studies have reported an increased risk of both acute and chronic renal dysfunction with use of nonselective NSAIDs." Research

"Long-term, continuous use of all NSAIDs, except for aspirin, may increase the risk of heart attack or stroke. Aspirin is a non-selective NSAID, but it has been shown in clinical trials to reduce the risks of cardiovascular events. " Research

"NSAID's (non-steroidal anti-inflammatory drugs), antacids, aspirin and ibuprofen are considered a direct cause of Leaky gut syndrome"


The second most common are SSRIs, or Serotonin reuptake inhibitors, antidepressants

Note: The Combined use of SSRIs and NSAIDs increases the risk of gastrointestinal adverse effects. Research PDF file

Risks and adverse effects of the SSRI's themselves:

"There is a risk that antidepressant treatment will cause an increase, rather than a decrease, in depression. In fact, all depression medications are required by the FDA to carry a warning about the increased risk of suicide, hostility, and agitation." Research

Common side effects of SSRIs: Insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, weight gain, sexual dysfunction, nausea, diarrhea, daytime fatigue.

Less common, but well known effects: tics, muscle spasms, dyskinesia (repetitive muscle movements), parkinsonism (rigid and trembling limbs, a shuffling gait, loss of fine motor control), and akathisia (compulsive restlessness). Research Harvard Mental Health

Side effects of older antidepressants, the tricyclics, for example: Elavil (amitriptyline) include: dry mouth, postural blood pressure changes (drop in blood pressure when getting up quickly, resulting in dizziness), difficulty urinating, weight gain and drowsiness, blurred vision, constipation, tachycardia, loss of sex drive; erectile failure; increased sensitivity to the sun; sedation (sleepiness); increased sweating, jitteriness, irritation, and difficulty falling or staying asleep.

Tricyclic antidepressants (e.g., imipramine) vary widely in their potency to promote NREM sleep, but all potently suppress REM sleep. Atypical antidepressants (e.g., fluoxetine, nefazodone) initially interfere with sleep, followed by increased NREM (particularly nefazodone). REM sleep is strongly reduced. Stanford University


Other antidepressants

Prozac: restlessness, insomnia, anxiety, headache, asthenia, flu-like symptoms, fever, nausea, diarrhea, anorexia, dry mouth, constipation, flatulence, dyspepsia, vomiting, somnolence, yawn, abnormal vision, sweating, trembling, weakness, weight loss, skin rash, delayed ejaculation in men, decrease in sex drive, and there have been reports of subsequent weight gain Indications for Prozac

Wellbutrin: Agitation, constipation, dizziness, dry mouth, excessive sweating, headache, nausea, vomiting, skin rash, sleep disturbances, tremor. Indications for Wellbutrin

Trazodone: The most frequent side effects are: dry mouth, constipation, and urinary retention. Increased heart rate, sedation, irritability, dizziness, and decreased coordination can also occur. As with most side effects associated with antidepressants, the intensity is highest at the beginning of therapy and tends to decrease with continued use. Indications for Trazadone

Savella: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania are common, as well as increased suicidal risk. "The efficacy of Savella for the management of Fibromyalgia was established in two double-blind, placebo-controlled, multicenter studies in adult patients  (18-74 years of age).  Indications for Savella 

Enrolled patients met the American College of Rheumatology (ACR) criteria for Fibromyalgia .... Approximately 35% of patients had a history of depression. Study 1 was six months in duration and Study 2 was three months in duration. A larger proportion of patients treated with Savella than with placebo experienced a simultaneous reduction in pain from baseline of at least 30% (VAS) and also rated themselves as much improved or very much improved based on the patient global assessment (PGIC)" RX List  


BRAND NAME: Cymbalta

DRUG CLASS AND MECHANISM: "Duloxetine is a selective Serotonin and norepinephrine reuptake inhibitor (SNRI) used for treating depression, anxiety disorder and pain associated with diabetic peripheral neuropathy or Fibromyalgia."

DRUG INTERACTIONS: "Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping duloxetine before starting an MAOI.

Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma. Similar reactions may occur if duloxetine is combined with anti psychotics, tricyclic antidepressants or other drugs that affect Serotonin in the brain (for example, tryptophan, and sumatriptan (Imitrex)."

"Fluoxetine (Prozac, Serafem), paroxetine (Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox), and quinidine (Quinidine Gluconate, Quinidine Sulfate) increase blood levels of duloxetine by reducing its metabolism in the liver. Such combinations may increase adverse effects of duloxetine."Med net

FM and Depression, more information, on site link


Anticonvulsants:

Lyrica: side effects include, dizziness and sleepiness, weight gain, swelling of the hands and feet, and dry mouth, drowsiness, anxiety; blurred vision; loss of balance or coordination; problems with memory or concentration; skin rash or itching; constipation, stomach pain; increased appetite; or joint or muscle pain. Indications for Lyrica

Gabapentin: Most common include, unsteadiness, clumsiness, and uncontrollable back-and-forth eye movements or eye rolling. Less common side effects include depression, irritability, other mood changes or changes in thinking, and decreased memory.Effects that are common when first starting the medications, that are said to lessen with time are : blurred or double vision, muscle weakness or pain, swollen hand, feet, or legs, trembling or shaking, and increased fatigue or weakness. 

Less common side effects that occur when initiating gabapentin treatment include back pain, constipation, decreased sexual drive, diarrhea, dry mouth and eyes, frequent urination, headache, indigestion, low blood pressure, nausea, ringing in the ears, runny nose, slurred speech, difficulty thinking and sleeping, weight gain, twitching, nausea and/or vomiting, weakness. Indications for Gabapentin 

Tegretol: Most common are, Nausea, vomiting, dizziness, drowsiness, or unsteadiness. Rare but serious side effects: swelling of the ankles or feet, fatigue, changes in heartbeat, persistent or severe headache, fainting, trouble urinating, change in how much urine ( greater or lesser is produced ), decreased sexual ability, unusual eye movements , general vision changes, hearing problems, pain, redness, swelling of the arms or legs, numbness, tingling of the hands or feet, sun sensitivity, joint pain, hair loss, depression, suicidal thoughts or attempts, or other mental-mood problems. Indications for Tegretol

Dilantin: dizziness, drowsiness, difficulty focusing, unsteady gate, tiredness, involuntary movements, nausea, vomiting, constipation, abdominal pain,  loss of appetite, rashes, some may be severe, darkening coloration of the skin, unusual growth of hair, affects the arms and legs but can also affect the trunk and face; it may be irreversible.Lymph nodes may swell up, serum glucose may rise,  injury to the liver (rare) platelet or white blood cell counts may drop, risk of bleeding or infection, anemia. Problems with vitamin D metabolism causing, (osteomalacia bone weakness). sexual dysfunction, impotence, and or priapism (painful, prolonged erections), increased risk of suicidal thinking and behavior. Indications for Dilantin

Depakote: tiredness, dizziness, upset stomach, vomiting, tremor, hair loss, weight gain, changes in behavior, depression, headache, diarrhea, cough, bleeding gums, joint or muscle pain, euphoria, loss of appetite, fever, depression, difficulty breathing, difficulty sleeping, sore throat, unusual bruising. Indications for Depakote


Muscle relaxants:

Flexeril: fatigue-tiredness, asthenia ( weakness), nausea, constipation, dyspepsia, unpleasant taste, blurred vision, headache, nervousness, and confusion.  Indications for Flexeril

Robaxin: Most common: Blurred vision; confusion; dizziness; double vision; drowsiness; fainting; fever; flushing; headache; indigestion; lightheadedness; metallic taste in mouth; mild muscle poor coordination; nasal stuffiness; nausea; pain and sloughing at the injection site; "pink eye;" rapid eye movement; sleeplessness; swelling; vomiting. Severe allergic reactions, contact doctor if : (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue), memory loss, seizures, slow heartbeat, yellowing of the skin or eyes. 
Indications for Robaxin.

Soma: Side effects may include: agitation, depression, dizziness, drowsiness, facial flushing, fainting, headache, hiccups, inability to fall or to stay asleep, irritability, light-headedness when standing up, loss of coordination, nausea, rapid heart rate, stomach upset, tremors, vertigo, vomitingRare and more serious side effects such as:allergic reaction, tremor, loss of vision, agitation, or shakiness. Indications for Soma

Skelaxin: dizziness, drowsiness, headache, irritability, nausea, nervousness, upset stomach, vomiting. Severe side effects- allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue), fever, chills, or sore throat, unusual or severe tiredness or weakness, yellowing of the skin or eyes. Indications for Skelaxin

Norflex: difficulty urinating, dizziness or drowsiness, dry mouth, headache,  blurred vision, nausea constipation or stomach upset, tremors. Severe side effects include: confusion abnormal behavior hallucinations. Allergic reactions (throat closing, difficulty breathing, swelling of  lips face tongue, or hives), fast or irregular heartbeat. Indications for Norlex

"The most common adverse effects of muscle relaxants, as a class are: vision changes, such as double vision or blurred vision, dizziness , lightheadedness, drowsiness, and dry mouth . These problems usually go away as the body adjusts to the drug and do not require medical treatment. They can also cause less common side effects, such as stomach cramps or pain, nausea and vomiting, constipation , diarrhea , hiccups , clumsiness or unsteadiness, confusion, nervousness, restlessness, irritability, flushed or red face, headache , heartburn , weakness, trembling, and sleep problems" Drug Information


Anti-Spastic Medications

Zanaflex: an inhibitor of Substance P, acts on the central nervous system. Possible side effects are: dry mouth, diarrhea, constipation, drowsiness, nightmares, abnormal movements, blurred vision, dizziness, frequent urination, low blood pressure, nervousness, runny nose, slow heartbeat, sore throat, speech disorders, urinary and other infections, vomiting, weakness or fatigue. More severe reactions may be: feeling light-headed, fainting, slow heart rate; hallucinations, confusion, unusual thoughts or behavior; nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools ( a sign of possible liver dysfunction), yellowing of the skin or eyes; burning or pain when you urinate. Indications for Zanaflex

Lioresal: (Baclofen) Side effects can include:drowsiness, feeling anxious, nervous, numbness or tingling, stomach pain, diarrhea, constipation, vomiting, fever, dry mouth, muscle weakness, back pain, increased muscle tone, muscle spasms, sweating or skin rash. Rare but more serious side effects seizure (convulsions),confusion, hallucinations, or an uneven heartbeat. Do not suddenly stop taking Baclofen, as rebound spasticity of the muscles may occur, causing damage to the muscle tissues. Indications for Lioresal


Other medications

Benedryl (dyphenhydramine): Most common, drowsiness, thickening of mucus, antihistamine hangover. Less common: Blurred vision, confusion, difficult or painful urination, dizziness, dryness of mouth, nose, or throat, fast heartbeat, sensitivity of the skin to sunlight, increased sweating, loss of appetite, nightmares, ringing or buzzing in ears, skin rash, stomach upset or stomach pain. Indications for Benedryl

Ambien (zolpidem tartrate): daytime drowsiness, dizziness, drugged feeling, headache, indigestion, nausea. It is a hypnotic and can make one more susceptible to suggestion during the fall asleep phase. Drug information

Ultram: side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less common side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. Possibility of seizures. Abrupt withdrawal of tramadol may result in anxiety, sweating, insomnia, rigors, pain, nausea, diarrhea, tremors, and hallucinations. Indications for Tramadol

Klonopin (clonazepam): side effects are sedation, dizziness, weakness, and unsteadiness. Other side effects include a feeling of depression, loss of orientation, headache, and sleep disturbance. Indications for Klonopion

Imitrex (sumatriptan): should not be taken by patients with history, symptoms, or signs of ischemic cardiac, cerebrovascular, or peripheral vascular syndromes. Contradictions and risk factors

Inderal (propranolol HCl):should not be taken by patients with history of, Bronchospasm, including bronchial asthma, allergic rhinitis, sinus bradycardia, cardiogenic shock, pulmonary hypertension, and congestive heart failure . Indications for Inderal

Xanax (Alprazolam): Drowsiness, dizziness, coordination difficulties. Release of hostility and other paradoxical effects, such as irritability and hallucinations. Indications for Xanax 

Duragesic Patches: ( trans-dermal fentany) releases narcotic medicine through the skin. Side effects may include: constipation, diarrhea, dizziness, drowsiness, dry mouth, headache, indigestion, loss of appetite, nausea, nervousness, anxiety, mild redness, swelling, discomfort of the skin at the application site, sleeplessness, stomach pain, sweating, vomiting. Severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue), chest pain, confusion, coughing up blood, difficulty urinating, difficulty talking, thinking, or walking, difficultly shallowing, slow breathing, excessive dizziness, drowsiness, fainting, fast, slow, or irregular heartbeat, fatigue, fever,, hallucinations, mood or mental changes, memory loss, muscle rigidity, numbness or tingling, persistent sore throat, seizures, shortness of breath, tremor, vision problems, weakness. Indications for Duragesic patchs

Lidoderm Patches, 5% lidocaine, local anesthetic: Generaly mild side effects at the application site. These include: mild redness, swelling, burning, blistering, bruising, irritation, change in skin color, numbness.  More serious side effects internally: weakness, confusion, disorientation, dizziness, headache, light headed, metallic taste, nausea, nervousness, increased pain, numbness, drowsiness, blurred vision, skin flushing, ringing ears or tremors. Severe side effects or allergy.  See a doctor immediately if you experience: hives, itching, trouble breathing, chest tightening, swelling of the face, mouth lips, changes in heart rate, mood swings, mental changes, nervousness, shallow breathing or shortness of breath ... all of which can lead to (Rare) cardiac arrest. Indications for Lidoderm

Armour Thyroid: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in appetite; changes in menstrual periods; changes in weight; chest pain; diarrhea; excessive sweating; fast or irregular heartbeat; headache; inability to tolerate warm or hot temperatures; nervousness; pounding in the chest; shortness of breath; trembling; tremors; trouble sleeping; vomiting. Drug Interactions

Note: this medication interacts with many common FM medications ie: Lyrica (pregabalin) Ambien (zolpidem) as well as a number of other drugs and more common herbs and vitamins.