Drug regimens for fibromyalgia

For advice on how to choose a drug for fibromyalgia, see Drug choice for fibromyalgia.

The goal of pharmacological therapy is to achieve functional improvement without causing adverse effects; this is best achieved with a low starting dose and that is increased in small increments, as described below.

For the treatment of fibromyalgia; use:

1amitriptyline 10 to 25 mg orally, in the early evening; increasing the daily dose by up to 25 mg every 2 to 4 weeks as tolerated and according to response, up to a maximum maintenance dose of 50 mg each evening amitriptyline amitriptyline amitriptyline

OR

1dosulepin 25 mg orally, in the early evening; increasing the daily dose by up to 25 mg every 2 to 4 weeks as tolerated and according to response, up to a maximum maintenance dose of 75 mg each evening dosulepin (dothiepin) dosulepin (dothiepin) dosulepin (dothiepin)

OR

1nortriptyline 10 to 25 mg orally, in the early evening; increasing the daily dose by up to 25 mg every 2 to 4 weeks as tolerated and according to response, up to a maximum maintenance dose of 100 mg each evening nortriptyline nortriptyline nortriptyline

OR

2duloxetine 30 mg orally, daily; increasing after 1 month to 60 mg daily. Titrate to response and tolerability. Maximum maintenance dose of 60 mg twice daily duloxetine duloxetine duloxetine

OR

2gabapentin 100 to 300 mg orally, in the early evening; increasing to 3 times daily as tolerated and according to response, up to a maximum dose of 2400 mg daily in 3 divided doses. Do not increase the dose more frequently than every 4 days gabapentin gabapentin gabapentin

OR

2pregabalin 25 to 75 mg orally, in the early evening; increasing to twice daily after 3 to 7 days and then increasing slowly as tolerated and according to response, up to a maximum maintenance dose of 450 mg daily in 2 divided doses. pregabalin pregabalin pregabalin