• Pregabalin (Lyrica)—Used to reduce pain associated with fibromyalgia and improve sleep and fatigue. In one study, patients taking pregabalin reported significant improvement in the quality of sleep compared to those who received placebo, as assessed by daily sleep diaries and a sleep scale measurement. Additionally, patients taking pregabalin reported reduced fatigue, distress, and degree of interference in activities of daily living. The most common side effects of pregabalin include mild-to-moderate dizziness and sleepiness. Blurred vision, weight gain, dry mouth, and swelling of the hands and feet also were reported in clinical trials. The side effects appeared to be dose-related. Pregabalin can impair motor function and cause problems with concentration and attention.
• Selective serotonin reuptake inhibitors (SSRIs)—Used both for depression and pain management.  Examples include fluoxetine hydrochloride (Prozac), paroxetine (Paxil), and sertraline hydrochloride (Zoloft).
• Tricyclic antidepressants—Used to help with sleep, such as amitriptyline (Elavil), nortriptyline (Pamelor) and imipramine (Tofranil). Although these medications can be helpful, they also may have side effects that are problematic, such as weight gain (particularly associated with amitriptyline), dizziness and dry mouth.
• Other medications—Trazodone is very effective for sleep and often has fewer side effects than the tricyclic medications.  Venlafaxine(Effexor) has effects on the serotonin system as well as other neurotransmitters and has been show to be helpful in the treatment of chronic pain.

 Medications that often are prescribed, but are of questionable benefit include

• Anti-inflammatory medications (ibuprofen, celecoxib [Celebrex])—These are not helpful, as there is no inflammation to reduce with fibromyalgia.  They are sometimes used as simple analgesics (pain relievers).  Acetominophen (Tylenol) has less risk of complications and would be a better choice.

• Muscle relaxants (carisoprodol [Soma], cyclobenzaprine [Flexeril])—These medications tend to lose their effectiveness over time. Cyclobenzaprine is a tricyclic medication and is sometimes used just at night to improve sleep.

• Opioids (acetaminophen with codeine, oxycodone, morphine, hydrocodone)—Long-term use of these medications does not necessarily decrease pain associated with fibromyalgia, and can even contribute to more pain in the long run.

• Herbal medications (St. John's Wort, Kava Kava)—The US Food and Drug Administration (FDA) does not regulate these medications, and limited research is available regarding their effectiveness.  It is important to let your health care provider know what herbal medications you are taking.  Some herbal medications can interact adversely with prescription medications.