This list is not inclusive but names some of more common treatments used for FMS and CFIDS
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Elavil (Amitriptyline) dose is typically 2.5 to 50 mg per night. Elavil is known for pain relieving effects and ability to help sleep. This medication should be taken early in the evening, or half-dose in the evening and the other half at bedtime to avoid morning hangover.
Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic drug similar to Elavil with muscle relaxant qualities. May be taken along with Elavil to provide muscle relaxant relief. This medication usually reaches its maximum effect after one to two weeks of continuous use.
Sinequan (Doxepin) a typical dose is 2.5 to 75 mg. Also a tricyclic that functions in the body as an antihistamine. Available in tablet form as well as liquid.
Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar effects as Elavil but may be less sedating.
Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as effective as the other anti-depressants, however, is chemically different and may be less likely to cause side effects. Desyrel is a mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at night. It has also been reported to cause nightmares.
Many of the tricyclic anti-depressants have side effects that may be intolerable for some people. These include constipation, drowsiness, dry mouth and eyes, headache, heart rate abnormalities, increased sensitivity to sunlight, morning "hangover," and weight gain. These side effects may improve after patients have been using the medication for a few weeks. If not, the doctor should be consulted regarding another medication.
(anti-depressant and anti-anxiety properties)
Xanax (Alprazolam) a typical dose is 0.25 to 1.5 mg at night. Xanax has been found to be more effective if taken with 2400 mg (per day) of ibuprofen. However, Xanax may cause depression in some people, and has been known to be addictive. Xanax may be effective for some fibromyalgia patients if taken in low does.
Klonopin (Clonazepam) 0.5 to 1 mg at night is helpful in sleep myoclonus (arm and/or leg spasms). Klonopin may help patients who grind their teeth. It stays active in the body longer, and has the same possibility of being addictive as Xanax, and may cause depression in some people.
The anti-depressant and anti-anxiety properties of these medications can cause the following effects: Depression, drowsiness, impaired coordination, impaired memory, muscular weakness and/or concentration problems, and they are known to be addictive.
Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating tricyclics such as Elavil or Sinequan.
Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning.. This medication is the most potent of this type. A sedating medication may be needed at night in conjunction with Paxil. It can cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report having fewer side effects with Paxil as compared to Prozac.
Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven helpful for some patients. Sedating medication may also be needed to combat insomnia.
Serzone (Nefazodone) is the newest of these agents. As well as increasing serotonin, it also increases norespinephrine. Serzone's efficacy and side effects are similar to Effexor.
Effexor (venlafaxine hydrochloride) the usual dose is 27.5 mg two times per day. This dosage can be adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac-like drugs, however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness, anxiety, insomnia and increased blood pressure.
The following are some of the side effects of serotonin boosting medications: anxiety/nervousness, headache, insomnia, mood swings, sexual difficulties, nausea and stomach distress.
Norflex (Orphenadreine Citrate) is one to try if the patient does not respond to Elavil or Flexeril. The recommended dose is 50 to 100 mg twice a day. Norflex is a central acting analgesic muscle relaxant that has been found to decrease pain in some FMS patients. Norflex is most often taken at night, some patients are able to tolerate this medication in the morning as well.
Patients should be cautioned that muscle relaxants can cause drowsiness and they should not operate a motor vehicle when taking this type of medication. There are other muscle relaxants to try if these do not work.
Flexeril (Cyclobenzaprine) is a muscle relaxant and can be beneficial to help loosen the tightness of FMS muscles. Flexeril may be taken in combination with Elavil to provide maximum relief.
(Prescription medications at physicians discretion)
Analgesics generally recommended are: Tylenol, Tylenol with codeine, Vicodin, Darvon and Ultram. These medications are prescribed for pain at the physician's discretion.
These medications are generally prescribed for those requiring a greater analgesic effect than acetaminophen alone can deliver, and/or those who are allergic to, or cannot take, aspirin. The role of narcotic pain relievers in fibromyalgia is to temporarily relieve an exacerbation of FMS pain.
Sleep Medications - may be used occasionally during flares or when the patient is having severe sleeping problems. They can be habit forming, however, Ambien is thought to be less habit forming, is well tolerated, with few side effects, and there are no known drug interactions. This sleep medication should not be used more than two or three times a week.
NSAIDS (anti-inflammatories) Advil, Clinoril, Motrin, Naproxen, Relafen and Voltaren. Used alone, these anti-inflammatories have not proven effective in reducing FMS pain. However, Elavil and Xanax's effectiveness is increased when used in combination with ibuprofen (2400 mg per day). If the patient has arthritis, osteoarthritis or tendinitis these medications would be helpful in alleviating the pain.
Advil, Motrin, Naproxen, Relafen, etc., are non-steroidal anti-inflammatories. These medications can cause stomach upset and some patients have developed bleeding ulcers.
Zostrix cream (Capsaicin 0.25 percent) a topical analgesic that can be purchased over the counter. Zostrix is effective for relief of pain of arthritis in specific areas and has been shown to help FMS patients. It is suggested that it be used three to four times per day for maximum effectiveness. Zostrix can be extremely irritating to the eyes, so hands should be washed well after application.
Aurum - is composed of methyl salicylate, camphor and menthol, and has helped reduce pain in FMS patients.
Pain Control Formula - is a capsaicin product and is distributed by "To Your Health, Inc," a natural goods company that supplies herbal supplements, vitamins, etc., for FMS, chronic fatigue, arthritis and chronic pain patients. Catalogues available by calling 1-800-810-1406.
Pharmacists may recommend other topical creams with similar properties. There are many on the market that may be as effective.