From the Guidelines
SNRIs (serotonin-norepinephrine reuptake inhibitors) are effective medications for treating fibromyalgia, with duloxetine and milnacipran being FDA-approved options. The most recent and highest quality study, 1, recommends the use of SNRIs, such as duloxetine, for the treatment of fibromyalgia, especially in patients with insufficient response to nonpharmacologic interventions.
Key Points
- Duloxetine is typically started at 30mg daily for one week, then increased to 60mg daily, with some patients benefiting from doses up to 120mg daily.
- Milnacipran usually begins at 12.5mg once daily, gradually increasing to 50mg twice daily, with a maximum dose of 100mg twice daily.
- These medications work by increasing levels of serotonin and norepinephrine in the brain, which helps reduce pain signals and improve mood.
- Common side effects include nausea, dry mouth, constipation, dizziness, and increased sweating.
- Patients should take these medications consistently and understand that benefits may take 2-4 weeks to appear.
- It's essential to avoid abrupt discontinuation as this can cause withdrawal symptoms; dosage should be tapered gradually under medical supervision.
Considerations
- SNRIs are particularly helpful for fibromyalgia patients who also experience depression or anxiety alongside their pain symptoms.
- The use of tricyclic antidepressants, such as amitriptyline, may be considered, but with caution, especially in older adults, due to potential risks of confusion and falls, as noted in 1.
- A multidisciplinary approach, including non-pharmacological and pharmacological treatment modalities, tailored to the individual patient's needs, is recommended, as suggested in 1.
From the FDA Drug Label
Milnacipran hydrochloride tablets are selective serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the management of fibromyalgia. Milnacipran hydrochloride tablets are selective serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the management of fibromyalgia.
The role of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) in the treatment of fibromyalgia is to manage the condition. Key points about the use of SNRIs in fibromyalgia treatment include:
- Indication: SNRIs, such as milnacipran, are indicated for the management of fibromyalgia 2 2.
- Mechanism: SNRIs work by selectively inhibiting the reuptake of serotonin and norepinephrine, two neurotransmitters involved in pain regulation and mood. Note that the FDA label does not provide detailed information on the exact mechanisms by which SNRIs alleviate fibromyalgia symptoms.