Drug choice for fibromyalgia

Derry, 2016Lunn, 2014Moore, 2019Moore, 2014

Low-dose tricyclic antidepressants (TCAs) are often used as first-line therapy because they have few major adverse effects and may improve sleep, in addition to reducing pain. If low-dose TCAs are ineffective or poorly tolerated, consider a gabapentinoid or serotonin noradrenaline reuptake inhibitor (SNRI). Drug choice is influenced by patient factors, including comorbidities (eg an SNRI may be preferred in patients with comorbid depression), potential drug interactions and adverse effects (eg an SNRI may be preferable in patients with obesity), and drug cost.

Combination therapy can be used but should be employed with caution. The need for combination therapy should flag consideration for specialist referral.

For prescribing information, see Drug regimens for fibromyalgia.