What second-line medications are used in the treatment of fibromyalgia?

Updated: Apr 23, 2020
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
  • Print

The selective estrogen receptor modulator raloxifene (Evista), 60 mg every other day, is effective in improving pain, improving fatigue, reducing tender-point count, and improving daily functioning in postmenopausal women with fibromyalgia. [150]  Modafinil (Provigil), approved for narcolepsy and shift-work sleep disorder, 100-200 mg in the morning, can improve fatigue and cognitive disturbances. [151, 152]

A review of medical cannabis for the treatment of fibromyalgia by Habib and Artul concluded that the treatment had a significant favorable effect, with few adverse effects. The study included 26 patients, who used a mean dosage of 26 g per month, for a mean duration of 10.4 months. All the patients reported experiencing a significant improvement in every parameter on the Revised Fibromyalgia Impact Questionnaire after starting medical cannabis treatment, and 13 patients stopped taking any other medications for fibromyalgia. Eight patients experienced very mild adverse effects. [153]

Preliminary data suggest that the synthetic cannabinoid nabilone (Cesamet), in doses escalating from 0.5 mg daily to 1 mg twice daily, improves pain and anxiety in fibromyalgia. [154]  Beta-adrenergic antagonists such as pindolol or propranolol (Inderal), given in low doses at bedtime, can also improve pain and agitation.ref150}

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!