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Copyright ©The Author(s) 2017.
World J Pharmacology. Mar 9, 2017; 6(1): 1-10
Published online Mar 9, 2017. doi: 10.5497/wjp.v6.i1.1
Table 1 Currently recommended drugs for the management of fibromyalgia[9,30,31]
DrugMechanism of actionSymptom improved
AmitriptylineTricyclic antidepressantPain, sleep, fatigue
CyclobenzaprineTricyclic antidepressantSleep
DuloxetineSerotonin-noradrenaline reuptake inhibitorPain, sleep
MilnacipranSerotonin-noradrenaline reuptake inhibitorPain, fatigue
Pregabalinα2δ ligandPain, sleep, fatigue
TramadolWeak opioid and serotonin-noradrenaline reuptake inhibitorPain
Table 2 Emerging drug therapies with potential efficacy for the treatment of fibromyalgia
DrugMechanism of actionRegimeEffect on painSecondary domains accessed
Trial sponsorRef.
VAS-PSignificantly improvedNo observed effect
AgomelatineMelatoninergic receptor agonist and 5-HT2 receptor antagonist25 mg/d during 12 wk-1.06 (5.13 - 4.07)FIQ, anxiety, depression,Sleep disorder, cognitive/executive function, quality of life indexUniversity of Messina[34]
25-50 mg/d during 12 wk[35]
CapsaicinTransient receptor potential vanilloid 1 subunitsTopical 0.075% TID during 6 wkNo significant effectFIQ (-9.81), fatigue severity, depression, myalgic score, pressure pain thresholdAnxiety, physical functioningRheumatology Service at the Specialist Clinic of Cantabria[36]
Dronabinol (delta-9-tetrahydrocannabinol)CannabinolDaily dose 2.5 -15 mg during 7 mo-3.5 (7.9-4.4)Anxiety, depression, quality of lifeHeidelberg University[37]
DroxidopaNoradrenaline prodrug600 mg TID during 9 wk-1.64 (cf pl -0.74)FIQ (-9.72)Chelsea Therapeutics/Lundbeck[38]
EsreboxetineNoradrenaline reuptake inhibitor4/8/10 mg/d during 14 wk-1.55 - 1.85 (cf pl -0.42 - -0.76)FIQ (-3.88 to -7.12), PGIC score, GFI score (-0.30 to -0.64)SF-36 physical function scorePfizer[39]
IMC-1 Celecoxib + famciclovirViral suppression of herpes virusFixed dose combination during 16 wk-1.9FIQ (-17.5), PGIC, fatigueInnovative Med Concepts[40]
MelatoninEndogenous melatonin receptor ligand10 mg/d during 6 wk-1.74 (6.49-4.75)FIQ (-17.7), sleep, tender pointsBrazilian Committee for Development of Higher Education Personnel and National Council for Scientific and Technological Development[41]
10 mg/d plus 25 mg/d amitriptyline during 6 wk-2.1 (6.96-4.86)FIQ (-24.7), sleep, tender points
MemantineNMDA antagonist20 mg/d during 5 mo-1.9 (cf pl -3.1) (6.9-5.0)FIQ (-13.2), CGI, Quality of life score,Cognitive state, depressionAragon Institute of Health Sciences[42]
Mirtazapine (Org 3770)a2 adrenergic and 5-HT2 and 5-HT3 receptor antagonist15 mg/d during 1 wk then 30 mg/d during 12 wk-1.6 (cf pl -0.4)FIQ (-12.9), anxiety, depression, PGIC, quality of lifeMeiji Seika Pharma Co., Ltd.[43,44]
NabiloneCannabinoid receptor agonist0.5-1.0 mg during 4 wk-2.04 (cf pl -1.43)FIQ (-12.07), anxietyUniversity of Manitoba[45]
0.5-1.0 mg during 2 wkNo effectSleepPain, mood, quality of lifeWinnipeg Regional Health Authority[46]
NaltrexoneOpioid receptor antagonist4.5 mg/d during 12 wk-1.55 (cf pl -0.43)MoodSleep, fatigueStanford University[47]
PramipexoleDopamine agonist4.5 mg/d during 14 wk-2.48 (cf pl -1.77)FIQ (-9.57), physical function, fatigueMood, depression, anxiety, tender point score[48]
TD-9855Noradrenaline serotonin reuptake inhibitor20 mg/d during 6 wk-1.4 (cf pl -0.5)FIQ (-16.2), PGIC, global and cognitive fatigueTheravance Biopharm[49]
TNX102SL cyclobenzaprineNoradrenaline, serotonin reuptake inhibition, adrenergic and serotonin receptor antagonist1-4 mg/d during 8 wk-0.6 (cf pl -0.6)Fatigue, tenderness, sleep, depressionTonix Pharmaceuticals[50,51]
Trazodone5-HT receptor antagonist and serotonin reuptake inhibitor50-300 mg/d during 12 wk then trazodone/pregabalin (max 450 mg/d) during 12 wk-0.45FIQ (-10), fatigue, stiffness, anxiety, depression, PGIUniversidad de Granada[52]
-1.29FIQ (-13.4)
Table 3 Novel drugs in clinical trials for potential treatment of fibromyalgia
DrugMechanisms of actionDomainsTrial SponsorRef.
EMA401Angiotensin 2 receptor antagonistPainNovartis/Spiniflex[53]
FlupirtinePotassium channel activationPainNot available[54]
Mirogabalin (DS-5565)α2δ ligandPainDaiichi Sankyo[55]
SuvorexantOrexin receptor antagonistSleep, insomnia, painHenry Ford Health System[56]
YokukansanHerbal medication; glutamatergic and serotonergic systemsInsomnia, sleepSt Marianna University, school of Medicine[57]
ZYN001CannabinoidPain, quality of lifeZynerba[58]