There are three fibro drugs on the market: Cymbalta, Lyrica, and Savella. (Other drugs may be used off-label, meaning they aren’t specifically approved to treat fibro.)
Like all medications, they can carry certain risks. “The drug with no 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 at lower doses.”
One of the most common side effects of fibro drugs, reported by both doctors and patients, is dizziness.
In the clinical trials for Lyrica, the first drug approved specifically for fibro by the FDA, 31% of the patients who took the drug experienced dizziness (compared with 9% of those who took a placebo).
“I always tell (patients) to be careful driving, operating equipment, climbing up and down ladders, riding a bicycle—anything that involves balance,” says Dr. Fraifeld.
An upset stomach is one of the most common side effects of both Cymbalta and Savella, says Jacob Teitelbaum, MD, the medical director of the Fibromyalgia and Fatigue Centers, a nationwide chain of treatment centers.
About 20% of Cymbalta users, and roughly 25% of Savella users, stop taking their medication because of nausea and other adverse reactions, he says.
Nausea is a less common side effect for people using Lyrica.
Lyrica and Cymbalta can produce some swelling in the legs, hands, and feet, although this is one of the less frequent and less severe side effects.
An antiseizure medication called gabapentin (brand name Neurontin) is often prescribed off-label as an alternative to these drugs, Dr. Teitelbaum says, because it’s cheaper, effective, and less likely to cause swelling (as well as the weight gain experienced by some Lyrica users).
About 22% of people who took Lyrica in a clinical trial experienced sleepiness (compared with 7% of those who took a placebo), and other fibro drugs can make you drowsy as well.
Painkillers stimulate chemicals in the brain that decrease brain activity, says Dr. Teitelbaum. As a result, these drugs can cause some sedation.
For some people, drowsiness can be a plus, he says. Since many people with fibromyalgia have trouble sleeping, taking drugs with a sedating effect may actually be helpful.
Fibromyalgia is sometimes associated with an autoimmune disorder that zaps your ability to produce saliva (called Sjogren syndrome), and fibro meds can make that dry mouth even worse.
Dry mouth might not sound like a big deal, but it can cause cavities and even require people to have their teeth removed, says Dr. Teitelbaum.
He suggests sucking on sugar-free candy or chewing sugar-free gum to help stimulate saliva production. If you experience dry mouth, you may also want to discuss lowering your medication dose with your doctor.
Interactions with other drugs
People with fibromyalgia may have other health problems as well, and about 70% take more than one medication regularly.
Often, says Dr. Teitelbaum, fibro patients are taking multiple medications that raise the brain chemical called serotonin.
“If you find you have anxiety and a racing heart, it may be because the mix of medication is raising serotonin too high,” he says. “You might want to ask your doctor to lower the dose.”
Cymbalta is a type of antidepressant known as a serotonin-norepinephrine reuptake inhibitor (SNRI).
SNRIs raise blood pressure in many people who take the drugs, so patients should be screened regularly for hypertension.
Savella, another type of SNRI indicated for fibromyalgia, may also increase heart rate or cause heart palpitations.
All three of the drugs approved for fibromyalgia by the FDA have prominent warnings about a possible increase in suicidal thoughts or behavior.
Most antiseizure and antidepressant drugs carry a warning about suicide, and fibro drugs fall in this category: Lyrica is an anticonvulsant 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 worsening depression or unusual mood changes.
“Lyrica is chemically related to medications that stimulate your body’s natural Valium, a brain chemical called GABA,” says Dr. Teitelbaum. “Because of that, it contributes to a little lack of mental clarity.”
The cognitive cloudiness known as fibro fog is common even in fibromyalgia patients who aren’t taking medication, so if you feel that you are growing increasingly confused after you start taking a drug, discuss it with your doctor.
It may or may not be related to your medication.
Lyrica—but not Cymbalta or Savella—has been shown to foster weight gain. For most people, only doses higher than 300 milligrams a day will cause them to pack on a few extra pounds, says Dr. Teitelbaum.
Even a few pounds can be significant, however, since weight gain is a common problem in fibromyalgia to begin with. “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 really lowers their self-images.”