Class

Compound

Treating Fibromyalgia Symptom

Pain

Sleep

Fatigue/ Cognitive Impairment

Mood

Tricyclic

Antidepressants

Cyclobenzaprine (Flexeril)

10 – 40 mg

(Although marketed as a muscle relaxant, it is chemically similar to TCA's.)

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Use all 1-2 hours before bedtime beginning at 10 mg and escalating by 10 mg /week as tolerated

Amitriptyline (Elavil)

10 – 50 mg

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Nortriptyline (Pamelor)

10 – 50 mg

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+

Doxepin (Sinequan)

10 – 50 mg

+

+

Dual reuptake

inhibitors

Venlafaxine (Effexor)

37.5 mg XR to 300 mg XR

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Duloxetine (Cymbalta)

20 mg twice a day

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Antidepressants: Other

Trazodone (Desyrel)

50 - 150 mg

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Nefazodone (Serzone)

100 – 300 mg

+

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Bupropion (Wellbutrin or Zyban)

150 mg SR

+

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Mirtazapine (Remeron)

15 – 45 mg

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5-HT reuptake inhibitors

(SSRI's)

Fluoxetine (Prozac)

10 – 80 mg

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Paroxetine (Paxil)

10 – 40 mg

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Sertraline (Zoloft)

25 – 100 mg

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Citalopram (Celexa)

20 – 60 mg

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NSAIDs

There may be added analgesic effect in combining NSAID's with other classes of medications especially if the patient has concurrent mechanical or inflammatory pain (e.g., osteoarthritis, tendonitis).

+

Antiepileptics

Gabapentin (Neurontin)

300 to 2,700 mg in divided doses with largest dose before sleep.

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Sedative/hypnotics

Zaleplon (Sonata)

5 – 10 mg

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Zolpidem (Ambien)

5 – 10 mg

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Opiates

Use sparingly

Other

Tramadol (Ultram)

50 mg - 100 mg QID PRN

Clonazepam (Klonopin)

0.25 – 1 mg

Stimulants

Amphetamine (Adderall or Dexadrine)

5 – 30 mg QD PRN

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Methylphenidate (Concerta or Ritalin)

Extended release tabs

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Pemoline (Cylert)

18.75 – 37.5 mg

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Modafinil (Provigil)

100 – 200 mg QD

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