Expert Bryan Arling's advice on Cymbalta, Savella, and other treatment options for fibromyalgia
Lyrica is prescribed for fibromyalgia, but its cost is excessive. Will Neurontin deliver the same relief?
Bryan Arling, M.D.: Lyrica (pregabalin) blocks calcium channels in the central nervous system and peripheral nerves. It is used to control seizures and also painful peripheral neuropathy such as that seen in some diabetics, some people after an outbreak of shingles (also known as post-herpetic neuralgia), or in nerve compression syndromes such as spinal stenosis and herniated lumbar discs. It has been found to be helpful in a significant percentage of people with fibromyalgia. Neurontin (gabapentin) is structurally similar to Lyrica and has a similar mechanism of action. Both are structurally related to the neural transmitter GABA, but neither drug seems to affect GABA uptake, release, or degradation. Both drugs can cause sleepiness, so it is good to start with a relatively low dose and gradually build up therapeutic levels. Likewise, one should taper off both drugs over a week or two to prevent seizures or other withdrawal symptoms.
I feel that it is essential that all patients thought to have fibromyalgia have their vitamin D3-25 levels checked. A significant number of these patients will be found to be vitamin D deficient, and many of their aches and pains will improve if they take 2,000 to 4,000 units of vitamin D3 a day.
Returning to an exercise program is one of the most helpful things that fibromyalgia patients can do. They need to start with very light exercise for just a few minutes and then gradually increase the intensity and duration of their exercise as their body allows them to do so. Additionally, one should do everything possible to optimize good sleep habits because symptoms often improve when the quality and duration of sleep improve.
Two other drugs have received FDA approval in the treatment of fibromyalgia. Cymbalta (duloxetine) and the just-released drug Savella (milnacipran) block the reuptake of the neurotransmitters norepinephrine and serotonin and hence are known as SNRIs, for serotonin norepinephrine reuptake inhibitors. There are other SNRIs available that may have benefits in fibromyalgia and may be less expensive. This would be an off-label use, and patients should find physicians who have used these other SNRIs in fibromyalgia patients.