These are not the only medications in use for FMS & CFS, but are simply a
selection to show what is available. It is our feeling that
medications should only be used as a "last resort", and if the patient is
already taking medications for the disease, the goal should be to wean off the
medications as soon as possible. YOUR BODY DOES NOT HAVE A
MEDICATION DEFICIENCY---unless you are diabetic or have hypothyroidism.
Medications should be used along with a program of proper diet, nutrition,
life style changes, and exercise. Medications which affect the central nervous
system are often prescribed for FMS. They target symptoms of insomnia, muscle
rigidity, pain and fatigue. Pain sensations are amplified by FMS, however many
FMS patients react badly to medications. Side effects of one medication
are often treated with another medication---and so on, and so on ....
If you are considering taking a medication, please check the list below to
see if this is something that you want to risk. If you are already
taking any of these medications, please note the side effects that you might
encounter:
Relafen (nambumetone): This pain reliever is an NSAID, and all
members of the NSAID family of drugs can cause gastrointestinal toxicity that
can lead to gastrointestinal bleeding and hospitalization or death.
This medicine can increase your risk of life-threatening heart or circulation
problems, including
heart attack or stroke. This risk will increase the longer you use Relafen.
Do not use this medicine just before or after having heart bypass surgery (also
called coronary artery bypass graft, or CABG).
Seek emergency medical help if you have symptoms of heart or circulation
problems, such as chest pain, weakness,
shortness of breath, slurred speech, or problems with vision or balance.
This medicine can also increase your risk of serious effects on the stomach
or intestines, including bleeding or perforation (forming of a hole). These
conditions can be fatal and gastrointestinal effects can occur without warning
at any time while you are taking Relafen. Older adults may have an even greater
risk of these serious gastrointestinal
side effects.
Call your doctor at once if you have symptoms of bleeding in your stomach or
intestines. This includes black, bloody, or tarry stools, or coughing up blood
or vomit that looks like coffee grounds.
Do not use any other over-the-counter cold, allergy, or pain
medication without first asking your doctor or pharmacist. Many medicines
available over the counter contain aspirin or other medicines similar to Relafen
(such as ibuprofen, ketoprofen, or naproxen). If you take certain products
together you may accidentally take too much of this type of medication. Read the
label of any other medicine you are using to see if it contains aspirin,
ibuprofen, ketoprofen, or naproxen. Do not drink alcohol while taking Relafen.
Alcohol can increase the risk of stomach bleeding caused by Relafen. Avoid
exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Relafen
can make your skin more sensitive to sunlight and sunburn may result.
Benedryl (dyphenhydramine):a helpful sleep aid/antihistamine which is
safe in pregnancy. This should be the first sleep medication tried. Some
patients have reported urinary retention. The starting dose is 50 mg 1 hr.
before bed. Increase as tolerated until symptoms are controlled or 300 mgs.
About 20% of patients react with excitation rather than sedation when taking
Benadryl. (non-prescription)
Do not take diphenhydramine if you have taken a monoamine
oxidase inhibitor (MAOI) such as isocarboxazid (Marplan),
phenelzine (Nardil), or tranylcypromine (Parnate) in the
last 14 days. A very dangerous drug interaction could occur,
leading to serious
side effects.
Before taking this medication, tell your doctor if you
have
 | glaucoma or increased pressure in the eye; |
| a stomach ulcer; |
| an enlarged prostate,
bladder problems or difficulty urinating; |
| an overactive thyroid (hyperthyroidism); |
| hypertension or any type of
heart problems; or |
| asthma. |
You may not be able to take diphenhydramine, or you may
require a lower dose or special monitoring during treatment
if you have any of the conditions listed above.
Desyrel (Trazodone): an antidepressant that helps with sleep problems.
It must be taken with food.
Atarax (hydroxyzine HCl): suppresses activity in some areas of Central
Nervous System to produce an anti-anxiety effect. This antihistamine and
anxiety-reliever may be useful when itching is a problem. Elavil (amitriptyline):
a tricyclic antidepressant (TCA) is cheap and sometimes useful. It generates a
deep stage four sleep. Most patients will adapt to this med after a few weeks.
It can cause photosensitivity and morning grogginess. It often causes weight
gain, dry mouth, as well as stopping the normal movements of the intestine. It
may cause Restless Leg Syndrome.
Wellbutrin (bupropion HCl): is a weak Specific Serotonin Reuptake
Inhibitor (SSRI) and antidepressant that is sometimes used in FMS & MPS Complex
in place of Elavil. It can promote seizures. It seems to be less likely to
promote sexual dysfunction than the most SSRIs.
Ambien (zolpidem tartate): hypnotic -- sleeping pill, for short-term
use for insomnia. There have been reports of serious depression, but some people
with FMS find it allows them to experience restorative sleep.
Soma (carisoprodol): acts on Central Nervous System to relax muscles,
not on the muscles themselves. It works rapidly and lasts from 4 to 6 hrs. It
helps detach from pain, and modulates erratic neurotransmitter traffic, damping
the sensory overload of FMS and muscular rigidity of MPS.
Flexeril (cyclobensaprine): this medication can sometimes stop spasms,
twitches and some tightness of the muscle. It is related chemically to Elavil.
It generates stage four sleep, but it may cause gastric upset and a feeling of
detachment from life. Sinequan (doxepin): heterotricyclic antidepressant
and antihistamine. It can produce marked sedation. This medication may enhance
Klonopin, but can reduce muscle twitching by itself.
Prozac (fluoxetine hydrochloride): anti-depressant that increases the
availability of serotonin, useful for those patients who sleep excessively, have
severe depression and overwhelming fatigue. Some people have reported profound
depression from Prozac.
Ultram (tramadol): non-narcotic, Central Nervous System medication for
moderate to severe pain, in a new class of analgesics called CABAs -- Centrally
Acting Binary Agents. Many people said it brought more alertness for longer
times, and less "fibrofumble" of the fingers. It can lower the seizure
threshold. Side-effects reported are grogginess, insomnia (may not be able to
take at night), headache or loss of sex drive. Some people have reported
profound depression resulting from Ultram.
Hydrocodone/Guaifenisen Syrup: This medication is generally given as a
cough suppressant. Each teaspoon contains 5 mg. Hydrocodone and 100 mg
Guaifenisen. It has no aspirin or ibuprofen. It may be effective for pain
medication, and can be "titrated" because it is in syrup form. The patient can
take very small amounts and can find the amount which works without causing
undue side effects."
Xanax (alprazolam):an anti-anxiety medication, that may be enhanced by
ibuprofen. It must not be used in pregnancy. It enhances the formation of blood
platelets, which store serotonin, and also raises the seizure threshold. When
stopping this medication, you must taper it very gradually. EMLA: a
prescription only topical cream, that may help cutaneous TrPs. It is a mixture
of topical anesthetics.
Pamelor (nortriptyline):this is used to help sleep. Some people find
it stimulating, and must take it in the morning. Others use it before bed to
help sleep. Some reports of depression with use.
Klonopin (clonazepam): anti-anxiety medication and anticonvulsive/
antispasmodic. It is useful in dealing with muscle twitching, Restless Leg
Syndrome and nighttime grinding of teeth.
BuSpar (buspirone HCl): may improve memory, reduce anxiety, helps
regulate body temperature, and is not as sedating as many other anti-anxiety
drugs. This medication often takes a few weeks to take effect.
Zoloft (sertraline):this is an SSRI and antidepressant, and is
commonly used to help sleep. It has less of an effect on liver enzymes than
other SSRIs.
Tagamet, Zantac, Prilosec, Axid: often used to counter esophageal
reflux. Tagamet may increase stage 4 sleep, and enhance Elavil. Acid suppressors
may interfere with B-12 absorption.
Paxil (paroxetine HCl):serotonin and norepinephrine reuptake
inhibitor, and may reduce pain. It should not be used with other meds that also
increase brain serotonin. Suggested dosage is 10 mgs (half a scored tablet) may
cause insomnia or drowsiness.
Effexor (venlafaxine HCl):Fast acting antidepressant and serotonin and
norepinephrine reuptake inhibitor. Suggested trial dosage is 25 mg, taken in the
morning. Food has no affect on its absorption. When discontinuing this
medication, taper off slowly. May raise blood pressure.
Inderal (propranolol HCl):sometimes helps in the prevention of
migraine headaches, although blood pressure may drop with its use. Antacids will
block its effect, and should not be used. May be very useful in decreasing
"adrenalin rush".
Librax: for Irritable Bowel Syndrome. It is a combination of
antispasmodic plus tranquilizer, that helps modulate bowel action.
Diflucan (fluconazole): this antifungal penetrates all of the body's
tissues, even the central nervous system. Very short term use can be considered
if cognitive problems and/or depression is present, and yeast is suspected.
Yeast may also be at the root of irritable bowel, sleep dysfunction (muramyl
dipeptides from bowel bacteria induce sleep), and other common FMS problems.
Imitrex (sumatriptan): this is available as an injectable solution or
pill that will not prevent migraines, but it is effective for migraine pain in
many cases. Works on serotonin release instead of blood vessel spasm, and may
provide relief in less than 20 minutes. It should not be used within 24 hours of
ergot (a common migraine drug) medications. It can increase blood pressure. It
may cause spasm of muscles in jaw, neck, shoulders and arms. Also reported were
tingling sensations, rapid heartbeat and the "shakes". Frequent use of Imitrex
may cause a rebound reaction, worsening migraines.
Remeron (mirtazapine): tetracyclic antidepressant, which effects
several neurotransmitters, including serotonin and norepinephrine. May cause
drowsiness and/or weight gain. Reported increase in cholesterol with some
patients.
Zanaflex (tizanidine): is a relatively new medication for muscle
tightness and pain. It also reduces muscle spasm frequency and myoclonus.
Effective dosage varies considerably in patients. May cause drowsiness."
COX-2 inhibitors:These medications will be out shortly. They block
cyclooxygenase-2, an enzyme that helps create enormous mounts of prostaglandins.
they not only seem to be effective for inflammation (FMS & MPS are not
inflammatory), but they may be a promising alternative to narcotics for pain
relief.
