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catfish hank
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Re: Fibromyalgia

Postby catfish hank » Fri Oct 18, 2013 12:38 pm

This is straight from UptoDate for those unresponsive to initial non-pharm therapy

Tricyclic antidepressants and related agents are often effective as initial treatment for patients with fibromyalgia. We suggest initiating therapy with a low dose of a tricyclic medication (eg, amitriptyline 10 mg) at night time, especially since these drugs are effective, widely available, and far less costly for most patients than some of the newer agents. The dose may be limited by adverse side effects, especially in older adults. In patients with mild to moderate symptoms, cyclobenzaprine is an alternative to amitriptyline.

Individual randomized trials have demonstrated that clinically important improvement occurs in 25 to 45 percent of patients treated with these medications, compared with 0 to 20 percent of those treated with placebo [36-43]. However, their use is limited by a lack of uniform effectiveness and by a relatively high frequency of side effects. In addition, the efficacy of the tricyclic drugs may decrease over time in some patients [40,44].

The doses of amitriptyline studied have been 25 to 50 mg, usually given as a single bedtime dose. These doses are usually lower than those required to treat depression. Nevertheless, even at low doses, dry mouth, constipation, fluid retention, weight gain, grogginess, and difficulty concentrating are common. Such side effects and possible cardiotoxicity limit use in older patients.

Desipramine is a tricyclic antidepressant that has been less well-studied for fibromyalgia but that remains a possible alternative because it generally has fewer anticholinergic side effects.

Regardless of the agent chosen, patients with fibromyalgia should be started on very low doses; a typical starting dose of amitriptyline or desipramine is 5 to 10 mg one to three hours before bedtime. The dose may be increased by 5 mg at two-week intervals. The final dose should be set by the patient, based upon efficacy and side effects, always keeping the dose as low as possible. A dose of 20 to 30 mg is adequate in many patients, and we do not exceed a dose of 75 mg in most patients.

Of note Cymbalta and Lyrica and avoid the anti-cholinergic side effects are often used for this condition but the above meds should be on the 7 dollar generic price list
Its easy to grin when your ship comes in
and you got the stock market beat.
And the man worth while is the man who can smile
when his shorts are tight in the seat... Smails.

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