Fibromyalgia

Table 5. Pharmacologic Treatment of Fibromyalgia Approved by the FDA Drug Duloxetine† ‡ Cymbalta® Dosage Form* Capsules: 20, 30, 60 mg Admin Route Usual Adult Dose PO Recommended dose: 60 mg once daily. Some patients may benefit from starting at 30 mg once daily. No evidence that doses over 60 mg/day confers benefit. Milnacipran† ‡ Savella® Pregabalin† Lyrica® Tablets: 12.5, 25, 50, 100 mg Capsules: 25, 50, 75, 100, 200, 225, 300 mg PO Dosing should be titrated: Day 1: 12.5 mg Day 2-3: 12.5 mg bid Day 4-7: 25 mg bid Aſter Day 7: 50 mg bid PO Begin dosing at 150 mg/day. Give in 2 divided doses. May be increased to 300 mg/day within 1 week. *See specific product labeling for complete prescribing information. † References Maximum Daily Dose 60 mg/day 200 mg/day 450 mg/day Black box warning: may increase risk of suicidal thinking or behavior in children, adolescents and young adults. ‡ Not approved for pediatric patients. 1. Goldenberg DL, Burckhardt CS, Crofford L. Management of fibromyalgia. JAMA. 2004;292:2388-2395. 2. Stanford SB. Fibromyalgia: psychiatric drugs target CNS-linked symptoms. Curr Psychiatr. 2009;8:37-50. 3. Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. 4. Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia. Ann Rheum Dis. 2008;67:536-541. J Rheumatol. 1991;18:728-733. 5. Burckhardt CS, Goldenberg DL, Croord L, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview (IL): American Pain Society; 2005. 6. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Arthritis Rheum. 1990;33:160-172. 7. Chandola HC, Chakraborty A. Fibromyalgia and myofascial pain syndrome-a dilemma. Indian Journal of Anaesthesia. 2009;53(5):575-581. 8. Cymbalta (duloxetine HCL) Delayed-Release Prescribing Information, Eli Lilly & Co., Indianapolis, IN. 9. Savella (milnacipran HCL) Prescribing Information, Forest Laboratories, New York, NY, and Cypress Bioscience, San Diego, CA. 10. Lyrica (pregabalin) Prescribing Information, Pfizer, New York, NY. Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. FIB061107 5740 Executive Drive Suite 218 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 For additional copies: orders@GuidelineCentral.com Copyright © 2011 All rights reserved

• Cover