The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions.

Your doctor may prescribe one or more of the following medications to help treat your fibromyalgia symptoms.

Tricyclic antidepressants

• Amitriptyline (Elavil)
• Desipramine (Norpramin)
• Doxepin (Sinequan)
• Imipramine (Tofranil)
• Trazodone (Desyrel)
• Nortriptyline (Pamelor)

Selective Serotonin-reuptake Inhibitors (SSRIs)

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

• Milnacipran (Savella)
• Duloxetine (Cymbalta)

Central Nervous System Depressants

• Zolpidem (Ambien)
• Zaleplon (Sonata)
• Sodium oxybate (Xyrem)

Opioids

• Morphine
• Oxycodone (OxyContin)
• Hydrocodone (Vicodin, Percocet)
• Hydromorphone (Dilaudid)
• Meperidine (Demerol)

Anticonvulsants

• Gabapentin (Neurontin)
• Pregabalin (Lyrica)

Pain Relievers

• Acetaminophen (Tylenol)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

• Aspirin
• Ibuprofen (Advil)
• Naproxen (Aleve)

Tricyclics are a class of antidepressants that may help relieve depression . At lower doses, they may help improve sleep and decrease muscle pain.

Possible side effects include:

• Dry mouth
• Blurred vision
• Constipation
• Decreased sexual drive or ability
• Weight gain
• Difficulty urinating
• Heart rhythm disturbances
• Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)

SSRIs increase levels of serotonin, a brain chemical that is associated with a sense of well-being. Serotonin may be decreased in some people with fibromyalgia.

Possible side effects include:

• Decreased sexual drive or ability
• Restlessness
• Nausea
• Headache
• Loss of appetite
• Weight loss
• Weight gain
• Insomnia
• Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)

SNRIs are type of antidepressant medicine that works by increasing the brain's levels of serotonin and norepinephrine (types of neurotransmitters). Milnacipran and duloxetine may reduce fibromyalgia pain.

Possible side effects include:

• Headache
• Nausea and vomiting
• Constipation
• Insomnia
• Dizziness
• Flushing
• Lightheadness
• Sleepiness
• Blurry vision
• Changes in thinking
• Nervousness
• Diarrhea
• Dry mouth (duloxetine)
• Decreased sexual drive or ability
• Risk of severe mood and behavior changes, including suicidal thoughts. (Young adults may be at a higher risk for this side effect.)

A common symptom of fibromyalgia is insomnia. Your doctor may prescribe a sleep medication, or hypnotic, such as zolpidem or zaleplon. Hypnotics are central nervous system depressants. They slow the nervous system by increasing the activity of a brain chemical that blocks neuron excitability.

It is best to use these medications only for brief periods of time. With longer use, you may become dependent on them. They should not be relied on for the long-term management of insomnia. Possible side effects include:

• Clumsiness or unsteadiness
• Dizziness or lightheadedness
• Slurred speech
• Nightmares
• Agitation
• Memory loss
• Dependency
• Sedation, drowsiness, and daytime sleepiness

Sodium oxybate is another central nervous system depressant. This medicine may help improve symptoms of fibromyalgia. Possible side effects include:

• Dizziness or lightheadedness
• Blurred vision
• Inability to think clearly
• Headache
• Nausea and vomiting
• Dependency—This medicine can lead to addiction. Your doctor will need to closely monitor you.

Opioids should only be used when all other pain management approaches have failed. They work by attaching to specific receptors in the body called opioid receptors. These receptors are found in the brain, spinal cord, and gastrointestinal tract. When these drugs attach to the receptors, they block the transmission of pain messages to the brain. Opioids can also induce a feeling of euphoria, by stimulating regions of the brain that mediate pleasure sensations.

Opioids can cause sedation and addiction. Their use needs to be carefully monitored by a physician.

Anticonvulsant medicines, like pregabalin and gabapentin, may be prescribed to reduce fibromyalgia symptoms, like pain and sleep problems. However, only pregabalin is approved by the Food and Drug Administration (FDA) to treat fibromyalgia.

Possible side effects include:

Acetaminophen is used to relieve pain. Unlike aspirin products, acetaminophen rarely causes stomach irritation or bleeding. However, people with liver disease or heavy alcohol consumption should avoid these drugs. Get your doctor's approval before using acetaminophen for more than a short time.

Do not combine acetaminophen with a monoamine oxidase inhibitor (used for depression, emotional conditions, or Parkinson's disease ). Ask a doctor before use if you are taking sedatives or tranquilizers.

NSAIDs are used to relieve symptoms, such as inflammation, swelling, stiffness, and pain. Since they may cause side effects, get your doctor's approval before using them for more than a short time.

Possible side effects include:

• Abdominal or stomach cramps, pain, or discomfort (mild to moderate)
• Diarrhea
• Dizziness, drowsiness, or lightheadedness
• Headache (mild to moderate)
• Heartburn , indigestion, nausea, or vomiting
• Allergic reaction with hives, swelling, or shock
• Asthma or shortness of breath
• High blood pressure
• Kidney problems
• Stomach irritation, ulcers, or bleeding
• Increased tendency to bleed

Whenever you are taking a prescription medication, take the following precautions:

• Take them as directed—not more, not less, not at a different time.
• Do not stop taking them without consulting your doctor.
• Don’t share them with anyone else.
• Know what effects and side effects to expect. Report them to your doctor.
• If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
• Plan ahead for refills so you don’t run out.

Last Reviewed October 2012