How are anticonvulsants used for the treatment of fibromyalgia?

Updated: Nov 14, 2018
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Anticonvulsants are useful for chronic pain states, including fibromyalgia and related syndromes and various types of neuropathic pain, and serve as adjunctive medications for disturbed sleep and anxiety. While multiple choices are available, the most studied options for fibromyalgia are gabapentin [144] and pregabalin (Lyrica). [145, 146, 121]  Other options include the following:

  • Tiagabine
  • Levetiracetam 
  • Topiramate 
  • Zonisamide
  • Oxcarbazepine 

Anticonvulsants often cause sedation, so they should be started using low doses at night with gradual up-titration and/or use during the day. One option for improving tolerability and efficacy of anticonvulsants is by combining them with antidepressants. Studies have shown benefits from combining pregabalin with milnacipran [147]  as well as gabapentin with venlafaxine, [148]  and the author's personal experience has shown that other combinations of anticonvulsants and antidepressants can result in augmentation.


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