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. Update: They are getting better at that, with paperwork often attached to the medication for side effects, now. But, they are not detailed enough ... 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. Placebos worked better, scary thought. Not a surprise, 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
drugs), antacids, aspirin and ibuprofen are considered a direct cause
Leaky gut syndrome"
The second most common given for FM, are SSRIs, or Serotonin re uptake 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.
Tricyclics 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
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, multi center 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: CymbaltaDRUG 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
more information, on site link
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 hands, feet, or legs, trembling or shaking, and increased fatigue or weakness.
common side effects
that occur when initiating gabapentin treatment include back pain,
decreased sexual drive, diarrhea, dry mouth and eyes, frequent
headache, indigestion, low blood pressure, nausea, ringing in the ears,
runny nose, slurred speech, difficulty thinking and sleeping, weight
twitching, nausea and/or vomiting, weakness. Indications
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 (
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
Flexeril: fatigue-tiredness, asthenia ( weakness), nausea, constipation, dyspepsia, unpleasant taste, blurred vision, headache, nervousness, and confusion. Indications for Flexeril
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.
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, vomiting. Rare 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
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
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 (transdermal fentanyl) 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.