DRUGS FOR FIBROMYALGIA (like Savella)

Fibromyalgia

This is a brief article about the 3 prescription drugs used specifically to treat fibromyalgia pain:

  • Cymbalta
  • Lyrica
  • Savella

The word "fibromyalgia" comes from the combination of several Greek words, and it simply means tissue or muscle pain, although the disease itself is far more complex than that. The term "Fibromyalgia" (FM), also known as "Fibromyalgia Syndrome" (FMS) was first coined in 1976. Currently the prevalence of fibromyalgia is about 2%, and is 7 times more common in females than in males.

Fibromyalgia symptoms include, but are not limited to:

  • Widespread pain on both sides of the body, both above and below the waist
  • Painful "tender points" on the body including the back of the head, shoulders, neck, chest, elbows, hips, inner knees and other places
  • Fatigue and sleeping difficulty

Many people with fibromyalgia also suffer from other conditions as well such as headache, osteoarthritis, depression or restless leg syndrome.

This article is about the prescription drugs marketed specifically for fibromyalgia. Although a variety of medications are used to treat the symptoms of fibromyalgia, there are currently just 3 prescription drugs which are specifically indicated to treat "fibromyalgia." The medical term is that these drugs are "indicated" for fibromyalgia. In other words, they have been specifically and carefully (through clinical trials) studied and tested on patients with this disease.

These prescription drugs to treat fibromyalgia are:

  1. CYMBALTA (duloxetine)
  2. LYRICA (pregabalin)
  3. SAVELLA (milnacipran)

The name in "( )" is the "generic name" of the product, although presently there are not any generics available for these 3 prescriptions drugs for fibromyalgia.

Although other drugs CAN be used to treat the pain associated with fibromyalgia, as I said, these 3 are the only prescription drugs specifically approved to treat fibromyalgia.

PLEASE NOTE: Nothing in this article is intended to replace the advice of your own doctor.

CYMBALTA FOR FIBROMYALGIA

Cymbalta began life as an antidepressant. But as with many drugs, new uses and opportunities were discovered. Presently Cymbalta is approved to treat depression, GAD (generalized anxiety disorder), Diabetic Neuropathy, and of course...fibromyalgia pain. Cymbalta is manufactured by Lilly Pharmaceuticals.

Cymbalta for fibromyalgia pain is dosed 60mg once daily, although patients sometimes start with just 30mg once daily.

Treating fibromyalgia pain with Cymbalta should not be considered a cure. Be prepared to give the medication several weeks to begin working effectively.

HOW IT WORKS: It is not well understood exactly how Cymbalta works to provide fibromyalgia relief. However, the mechanism of action involves enhancing the effects of serotonin and norepinephrine (2 important neurotransmitters) in the brain.

SIDE EFFECTS: Side effects from Cymbalta could include nausea, dry mouth, drowsiness, decreased appetite, and constipation. Other, less common side effects, are also possible.

DIRECTIONS: Take Cymbalta as prescribed by your doctor. It is usually taken once daily. It does not matter if it is taken with or without food. Ideally...take it at the same time each day.

DO NOT stop Cymbalta for fibromyalgia suddenly. It is recommended that you wean yourself off, under the advice and direction of your doctor.

MORE INFORMATION: For more information on treating fibromyalgia pain with Cymbalta CLICK HERE to visit the manufacturer website. Or call their special phone number for patient questions at 1-800-LILLY-RX.

LYRICA FOR FIBROMYALGIA

Like Cymbalta, Lyrica did not begin specifically as a treatment for fibromyalgia. Lyrica was first approved to treat seizure disorders. But in 2007 it became the first prescription drug in the U.S. approved to treat fibromyalgia. Lyrica is manufactured by Pfizer pharmaceuticals.

Lyrica comes in capsules, and an oral solution:

  • Capsules are available in 8 different strengths: 25mg, 50mg, 75mg, 100mg 150mg, 200mg, 225mg and 300mg.
  • The oral solution is available in 20mg/ml (that is 100mg per teaspoonful).

FIBROMYALGIA DOSAGE: Usually the total daily dose for fibromyalgia pain treatment begins at 150mg per day (i.e. 75mg capsule twice daily) and can go up to 450mg per day (i.e. 225mg twice daily).

HOW IT WORKS: If you can figure this one out...there may be a Nobel Prize in it for you! Studies have shown that it seems to act by binding to areas of the brain and spinal cord that could contribute to pain. More scientifically, it is known as an "alpha 2 delta ligand" and selectively targets calcium channel subunits. It is NOT to be confused with "calcium channel blockers" which impact calcium channels in our blood vessels. Basically, for now, think of it as a drug which calms the nerves.

SIDE EFFECTS: Lyrica for fibromyalgia pain may cause drowsiness and dizziness, weight gain, blurry vision, trouble concentrating, swelling of the hands and feet, and dry mouth. Other side effects can occur as well. Note: any swelling, difficulty breathing, or rash should be immediately reported to your doctor. Lyrica has been shown, rarely, to cause suicidal thoughts. Patients should be aware of this observation.

DIRECTIONS: Take Lyrica as directed by your doctor. Try to take it at the same times every day. It can be taken with or without food. Do not skip doses. Never double your dose to make up for a missed dose. Do not stop Lyrica suddenly.

For more information on Lyrica and how to treat chronic fibromyalgia, visit the manufacturer's website by CLICKING HERE!  They have a special phone number for fibromyalgia patients taking Lyrica: 1-888-5-LYRICA.

For a more detailed explanation of Lyrica, check out THIS ARTICLE published in the Cleveland Clinic Journal of Medicine in 2009.

SAVELLA FOR FIBROMYALGIA

Savella is a prescription medication for treating the pain of chronic fibromyalgia. Savella is marketed by Cypress Bioscience. It comes in tablets of 4 strengths: 12.5mg, 25mg, 50mg and 100mg. Savella for fibromyalgia belongs to the same "family" of medications as Cymbalta, but unlike Cymbalta, Savella is only approved for the treatment of fibromyalgia.

FIBROMYALGIA DOSAGE:  Generally the dose will be slowly increased over the course of 1 week to 50mg twice daily.  In some cases 100mg twice daily may be needed.

HOW IT WORKS: See this section in the Cymbalta information above, Savella works in the same way.

SIDE EFFECTS: The most common side effects associated with Savella are nausea, headache, constipation, dizziness, insomnia, vomiting, dry mouth, heart palpitations and increases in blood pressure. Suicidal thoughts, as with all similar medications, have been reported. This was more common in younger patients.

DIRECTIONS: Savella should be taken as directed by your doctor. Usually it is given twice daily, with our without food. Taking it with food may make it more tolerable if you experience stomach discomfort. Do NOT take Savella if you are taking any MAO Inhibitors. Do not stop taking Savella suddenly.

For more information of Savella, visit the manufacturer's webisite by CLICKING HERE!

HOW LONG DOES IT TAKE FOR THESE TO WORK?

That is a good question, and it depends very much on the patient.  A rule of thumb is "several weeks to a month."  The hard part is that the side effects may begin immediately!  However, you may not have any side effects at all.  And if it is any encouragement, remember that the side effects alert you that the medicine is doing something.  However, the beneficial effects may still take several more weeks to begin.  Hang in there.  I hope this information has provided you with some useful answers to your questions about drugs for fibromyalgia pain.

OTHER FREQUENTLY ASKED QUESTIONS

How much will these medications cost?

Cymbalta, Lyrica and Savella are currently only available as brand name products.  They are quite expensive, in the area of $150 to $175 per month, depending on the drug and dosage.  However, if you have a prescription benefit, you may be able to receive one of these medications more affordably.  Also, visit the respective manufacturers websites for coupons and discounts.

How do I get a prescription for these medications?

Talk to your doctor.  It is likely that they will have you try other medications first (like traditional pain relievers, muscle relaxers, or SSRI's).  If you have tried these without success, and have a diagnosis of fibromyalgia, then your doctor may be willing to consider treating you with one of these medications. 

 

 

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Comments 24 comments

DiamondRN profile image

DiamondRN 6 years ago from Charlotte, NC USA

That sure is a tough illness to treat, Phamacist.


Ms Dee profile image

Ms Dee 6 years ago from Texas, USA

I hadn't realized all these meds have come out to treat FMS. I found that Platinum Plus Amino Acids took my pain totally away in 5 weeks. I found it at supernutrient.com where some extensive articles are written about how the pancreous doesn't digest protein enough so DDD developes.


pharmacist profile image

pharmacist 6 years ago from Whitinsville, MA Author

Ms Dee,

So glad you found something that worked for you. Thanks for sharing!


Jillian Barclay profile image

Jillian Barclay 6 years ago from California, USA

Great information! I have taken Cymbalta with no help, then had to take gabapentin with swelling that was unbelievable and am now taking Lyrica. Some insurance companies require trials of other drugs first before allowing Lyrica to be used. The Lyrica has helped more than the other 2, but I don't think there has been anything developed that will take the pain away completely. People with fibromyalgia suffer more than anyone realizes and there is still stigma attached to the label of fibromyalgia. Some in the medical community don't even believe that fibromyalgia is a legitimate ailment. Anyone who has fibromyalgia must seek help from a rheumatologist, in my opinion. They may not know how to cure it, but at least they know it is a legitimate disease and they are best equipped (knowledge-wise) to help.


pharmacist profile image

pharmacist 6 years ago from Whitinsville, MA Author

Jillian,

Thank you so much for sharing this information. You give some great advice!


leeree profile image

leeree 5 years ago

I just started taking Savella three weeks ago. So far there is only a minor change. I also take cymbalta. In addition to fibromyalgia I have been diagnosed with primary eyrthromelalgia and Reynauds. The past several years have been terrible but I keep my hopes positive that doctors will come to realize that this is a real condition that needs serious consideration and research. My 16 year old son was just diagnosed with the eyrthromelalgia as well. He has an uphill battle ahead of him. Do you have any information on EM? I'd love to have a pharmacist point of view.


pharmacist profile image

pharmacist 5 years ago from Whitinsville, MA Author

Dear leeree,

I'm very sorry that I don't personally have any info on EM that you couldn't find with an online search. I hope the medication proves helpful, and if not, that you are able to get help from something else. Best wishes my friend!


Carol 5 years ago

Want to know what drugs over the counter or otherwise should not be taken by someone who takes Cymbalta? The drug works well for me but I am not sure what other meds don't mix well with it?


pharmacist profile image

pharmacist 5 years ago from Whitinsville, MA Author

Hi Carol,

The biggest concern are prescription drugs known as MAOI's. They are rarely used, but would be dangerous with Cymbalta. Some OTC meds that can thin the blood (aspirin, ibuprofen) may do so even more while on Cymbalta. Also, keep an eye on your blood pressure if taking any medicine that might also increase blood pressure (e.g. decongestants like sudafed).

Best wishes!


goshengril 4 years ago

I was diagnosed with fibromyalgia 1 1/2 yrs. ago. I have heard and read about Cymbalta, Lyrica, and Salvella. I have been on Lexapro, for depression, for a long time and it works quite well. My question is, can I take one of the fibro. meds. with the Lexapro? I hate to switch from an antidepressant that works so well for me.


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

goshengril,

It is not advisable to mix Cymbalta or Savella with Lexapro. Lyrica would be a possible drug to discuss with your MD.


Kathy 4 years ago

I also have fibromyalgia and was given savella. I had hallucinations within a week and went of it. I have been on cymbalta up to 90 mg a day along with lyrica up to 200 mg a day. I have had my lips swell up numerous times and was checked out and they were unsure of what caused it. A month ago I a=had a bizarre thing happen where it felt like lights from a camera were flashing. Also had high blood presssure, ongoing panic attacks, heart palpitations, hot flashes, shivering inside, headache and a general disconnect in my brain type of feeling. I was checked out in ER and they felt it was probably an allergic reaction to the lyrica and had weaned down already to 100 mg daily and they took me off cold turkey. I am doing somewhat better but my lips swelled back up again and am back on prednisone and still feeling quite a bit of the same side affects. Could this be the cymbalta or still the aftereffects of the lyrica? I also take ambien to stop muscle spasms to sleep. I see my neurologist thursday but they want me to see a psychiatrist to see if he can determine if it's allergic reactions of what. Feel like it's a neurological bad reaction to the meds and have read here that savella, cymbalta and lyrica are all related. Any ideas out there?

Kathy mikatr@cox.net


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

Kathy,

Your symptoms could be explained a variety of ways. It could be an allergy. It could be a drug interaction between the meds you mention. It could be a reaction to additional medicine and/or food. It could also be something called serotonin syndrome. All these, and possibly more, will need to be explored by your doctor. Work with him/her to identify the culprit. Best wishes!


trainerlex profile image

trainerlex 4 years ago from Denver, CO

Excellent hub. I was diagnosed with fibro last month and am only beginning to learn about the endless list of treatments. Having these three prescription options profiled so neatly is encouraging. There seems to be much speculation about fibro and few hard facts. Sifting through all that information is overwhelming, especially with "fibro-fog" to contend with. Thank you!


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

trainerlex,

Happy to have provided some helpful information. Best wishes on your sifting! I know it is difficult. Don't give up.


Debra Roges 4 years ago

What can be done about the accompanying symptoms such as the sleep disturbances and the restless legs?


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

Debra,

Definitely talk to your doctor about these symptoms. They may merit considering other medication alternatives. Otherwise, we do have some pharmacological approaches to sleep troubles and restless legs. Best to start with non-pharmacological treatments if possible.


nifwlseirff profile image

nifwlseirff 4 years ago from Leipzig, Germany

I was diagnosed with fibro about 8 years ago, trialling all these three, but settled with gapabentin (low dose, each night). It's certainly a tricky illness, everyone has different symptoms. Mine seems to be predominantly inflammatory - Raynaud's, Moreton's, sciatica, costo, headaches, etc., but I'm unable to have any anti-inflammatory medications due to a kidney defect. Sifting and trying various things to find what works for you, and not giving up, is the way to manage this disease. I think it's harder on the people around the fibromite, especially as they feel completely powerless.

Thanks for a useful hub!


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

nifwiseirff,

Thanks for reading, and even more for sharing your experience with the disease. Very helpful!


Emma Jones profile image

Emma Jones 4 years ago from New York, New York

hey goshengril, even I am taking lexapro for depression, and I am also going through similler kinda treatment. Doctor didn't actually took the name FM, but he told me tht lyrica and cymbalta could help me for pain in my back side of head. Some I dont have medical insurance, and want to order lyrica online, can any one help me with some nice online pharmacy where I can order those meds.

Thanks in advance

Emma


pharmacist profile image

pharmacist 4 years ago from Whitinsville, MA Author

Emma,

I personally don't recommend using an online pharmacy, unless you have insurance and they direct you to a "mail order" pharmacy. Otherwise, you take a big risk. Look into patient assistance programs to help pay for the meds. Best wishes.


WVBards profile image

WVBards 3 years ago from Seattle

These are solid meds but they really don't work for everyone! Sometimes it's the smallest details, like lack of sleep or lack of nutrition, that tips the scale.


pharmacist profile image

pharmacist 3 years ago from Whitinsville, MA Author

WVBards,

Very true, and meds are never recommended until lifestyle alterations have proven unsuccessful or impractical. Good points. Thank you.


Mary Lee 16 months ago

I also have Fibro. Going on 7 years now. I do take tramadol, but that's because I couldn't get out of bed without it. I know you build up a resistance and I am trying my best not to get on the strong pain killers, so I started at 1/2 pill twice a day. I am now at 3 pills 2x a day but it took me 7 years to get here. I have tried all 3 of these for fibro, Cymbalta worked for a little bit, then stopped, the others didn't help at all. I take a LOT of natural herbs, as I have all the raging symptoms of fibro, including serious joint pain, lower back pain, muscle pain and stiffness, brain fog, NO energy and migraines. First, most fibro patients have been found to be seriously low in D3 and Magnesium. Addressing that helps. Here is my daily regimen:

3 Magnesium Malate, which gives you the recommended amount of magnesium and malic acid for us fibro patients.

5,000 D3 with K2 (200 M-7 and M-4 ea) 680 Strontium - Much better than Calcium. I take these 3 all together and away from everything else. Low D3 needs all of these for absorption and bone health and so the excess calcium doesn't end up in your arteries.

Probiotics, Enzymes, Beta Glucan, SAMe, GliSODin, Morniga, Siberian Ginseng (the last 2 for energy) first thing in the morning. I also put D-Ribose powder in my allowed one cup of coffee.

Olive Leaf extract, Raw One Womens once a day vitamin after breakfast.

For my joints I take a LOT, but it keeps my joints and back mostly pain free and moving. If I run out of just one, my joints tell me within 2 days: Turmeric Boswellia & Tart Cherry, Type II Collagen, NEM Eggshell Membrane, CetylPure and Hyaluronic Acid. I also want to point out that all these things are also really great for your skin, hair and nails. They up your collagen production among other things. I am 52 and people are shocked at my age. For years I took Glucosamine and Chondroitin and I ran out of them and woke up the next day in much less muscle pain than normal. I had become almost bed bound at that point. SO when I got them back in, I started them back and the pain came roaring back. Testing proved this was aggravating my muscle pain. So if you take this for joint pain, you might want to test it out yourself.

Lastly, I take Krill Oil because it is essential for not only joints, but getting your cells opened to be able to absorb the nutrients in food and these herbs.

I have heel spurs which makes most exercise impossible, so I swim OR do my Yoga in Bed (there's an app for that ;) while on an oxygen machine every day. My furniture is also softly cushioned, as touching anything hard will result in throbbing pain at the point of contact that lasts for up to a day.

I was vegetarian and went gluten free and soy free for 6 months and it didn't make that big of a difference to the pain, but it did help me lose weight. Unfortunately, it was a hard regimen to maintain long term.

Yes, its A LOT, but it's still cheaper than any one of the meds they tried to put me on and I am still not pain free. I still have bad days, but overall, the pain is much less and easier to deal with.

I find it odd, and my doctor concurred, that GMO's entered our food supply about the same time that fibro symptoms started showing up. It's one of the reasons I am a huge supporter of GMO labelling. Right now, it's practically impossible to avoid them, but make them label and when they start seeing sales drop due to that GMO label, food makers will start demanding non GMO sources for their foods. I personally think that would eradicate Fibro. At least in future generations. I think the damage has already been done to us. I eat organic as much as possible, but I also eat out a lot, because it's hard to cook when you are in pain. So it's impossible to avoid them.

So that's my story and it's my hope that one day they find a cure for this. I wish all of you living with this more good days than bad! I hope my post can help some of you find relief.

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