Rheumatology Book

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Fibromyalgia Pharmacologic Management

Aka: Fibromyalgia Pharmacologic Management
  1. See Also
    1. Fibromyalgia
    2. See Fibromyalgia Non-Pharmacologic Management
  2. Management: Antidepressants
    1. Benefits
      1. Assists with local pain, stiffness and sleep
      2. Does not affect Tender Points
    2. Tricyclic Antidepressants
      1. Amitriptyline (Elavil)
        1. First week: 10 mg PO qhs
        2. Next three weeks: 25 mg PO qhs
        3. Later: 50 mg PO qhs
      2. Nortriptyline (Pamelor)
    3. Novel Antidepressants
      1. Venlafaxine (Effexor)
        1. Sayer (2003) Ann Pharmacother 37:1561-5
      2. Duloxetine (Cymbalta)
    4. Selective Serotonin Reuptake Inhibitors (SSRI)
      1. Combination: Fluoxetine and Amitriptyline
        1. Efficacy: Combination better than either drug alone
        2. Start SSRI and Amitriptyline dosing low
        3. Goldenberg (1996) Arthritis Rheum 39:1852-9
      2. Higher doses of Prozac required for effect
        1. Arnold (2002) Am J Med 112:191-7
    5. References
      1. O'Malley (2000) J Gen Intern Med 15:659-66
  3. Management: Anticonvulsants
    1. Pregabalin (Lyrica)
      1. Only anticonvulsant effective in Fibromyalgia
      2. Dose of 450 mg/day reduced pain, Fatigue, Insomnia
      3. Pain improvement was in reducing pain level rating from 7 to 4-5
    2. Reference
      1. Crofford (2004) Curr Rheumatol Rep 6:274-80
      2. Crofford (2005) Arthritis Rheum 52: 1264-73
  4. Management: Analgesics and other agents
    1. Acetaminophen (Tylenol) up to 1000 mg PO qid
    2. NSAIDs
      1. Less effective than in other rheumatologic disease
    3. Cyclobenzaprine (Flexeril)
      1. Dose: 10 mg (up to 30 mg has been used) at bedtime
      2. Assists with local pain, sleep and Tender Points
      3. Tofferi (2004) Arthritis Rheum 51:9-13
    4. Tramadol (Ultram)
  5. References
    1. Chakrabarty (2007) Am Fam Physician 76:247-54
    2. Goldenberg (2004) JAMA 292:2388-95

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