There are three drugs for fibro on the market: Cymbalta, Lyrica and Savella. (Other medications can be used off label, which means they are not specifically approved to treat fibro).
Like all medicines, they can carry certain risks. “The drug without side effects is only in our imagination,” says Eduardo Fraifeld, MD, president of the American Academy of Pain Medicine.
Fortunately, says Dr. Fraifeld, “most side effects become less problematic if you take the medication in lower doses.”
One of the most common side effects of medications for fibro, reported by doctors and patients, is dizziness.
In clinical trials for Lyrica, the first drug approved specifically for fibro by the FDA, 31% of patients who took the drug experienced dizziness (compared to 9% of those who took a placebo).
“I always tell the (patients) to be careful when driving, operating the equipment, going up and down stairs, riding a bicycle, anything that involves balance,” says Dr. Fraifeld.
Stomach upset is one of the most common side effects of both Cymbalta and Savella, says Jacob Teitelbaum, MD, medical director of the Centers for Fibromyalgia and Fatigue, a national chain of treatment centers.
According to him, approximately 20% of Cymbalta users and approximately 25% of Savella users stop taking their medications due to nausea and other adverse reactions.
Nausea is a less common side effect for people who use Lyrica.
Lyrica and Cymbalta may cause some swelling in the legs, hands and feet, although this is one of the less frequent and less serious side effects.
An anticonvulsant medication called gabapentin (brand name Neurontin) is often prescribed off the label as an alternative to these medications, says Dr. Teitelbaum, because it is cheaper, more effective and less likely to cause bloating (as well as increased blood pressure). weight experienced by some Lyrica Users).
About 22% of people who took Lyrica in a clinical trial experienced drowsiness (compared to 7% of those who took a placebo), and other medications for fibro can also cause drowsiness.
Analgesics stimulate chemicals in the brain that decrease brain activity, says Dr. Teitelbaum. As a result, these medications can cause some sedation.
For some people, drowsiness can be an advantage, he says. As many people with fibromyalgia have trouble sleeping, it may actually be useful to take medications with a sedative effect.
Fibromyalgia is sometimes associated with an autoimmune disorder that affects its ability to produce saliva (called Sjogren’s syndrome), and fibro medications can further aggravate dry mouth.
Dry mouth may not seem like a big problem, but it can cause cavities and even require people to remove their teeth, says Dr. Teitelbaum.
Suggests sucking sugar free candy or chewing gum without sugar to help stimulate the production of saliva. If you experience dry mouth, you may also want to talk with your doctor about reducing the dose of your medication.
Interactions with other drugs.
People with fibromyalgia can also have other health problems, and about 70% take more than one medication regularly.
Often, says Dr. Teitelbaum, patients with fibro take multiple medications that elevate the brain chemical called serotonin.
“If you discover that you have anxiety and an accelerated heart, it may be because the combination of medications is raising serotonin too high,” he says. “You may want to ask your doctor to reduce the dose.”
Cymbalta is a type of antidepressant known as a serotonin and norepinephrine reuptake inhibitor (SNRI).
SNRIs increase blood pressure in many people who take the drugs, so patients should be tested for hypertension regularly.
Savella, another type of SNRI indicated for fibromyalgia, can also increase heart rate or cause palpitations.
The three medications approved for fibromyalgia by the FDA have prominent warnings about a possible increase in thoughts or suicidal behaviors.
Most antidepressant and anticonvulsant medications carry a warning about suicide and fibro medications are included in this category: Lyrica is an anticonvulsant that is also used to treat seizures, Cymbalta is approved for the treatment of depression and anxiety, and Savella is related to antidepressants.
Patients and family members should watch for the worsening of depression or unusual mood swings.
“Lyrica is chemically related to drugs that stimulate your body’s natural Valium, a brain chemical called GABA,” says Dr. Teitelbaum. “That’s why it contributes to a small lack of mental clarity.”
Cognitive cloudiness known as fibro fog is common even in patients with fibromyalgia who do not take medication, so if you feel you are becoming more confused after you start taking a medication, talk to your doctor.
It may or may not be related to your medication.
Lyrica, but not Cymbalta or Savella, has been shown to encourage weight gain. For most people, only doses above 300 milligrams a day will increase a few extra pounds, says Dr. Teitelbaum.
However, even a few kilos can be significant, since weight gain is a common problem in fibromyalgia. “The average weight gain in fibromyalgia is 32.5 pounds,” says Dr. Teitelbaum. “Adding more weight gain in a disease that most often affects women actually decreases their own images.”