Fibromyalgia Medications: In-Depth Guide to Treatment

Medical Review by Andrea Chadwick, M.D., M.Sc., FASA | Last Updated: December 2025

Fibromyalgia medications are a crucial component of treatment for the millions of people managing this chronic pain condition. From FDA-approved options like pregabalin and duloxetine to the newly approved Tonmya, understanding how each medication works can help you make informed treatment decisions with your doctor.

Fibromyalgia is a chronic pain disorder that affects millions of people worldwide. Its symptoms are complex and can be very personal from patient to patient, but most frequently it is characterized by widespread muscle pain, fatigue, cognitive difficulties, and sleep disturbances. 

While there is no known cure for fibromyalgia, the good news is that treatment can make a significant difference in improving symptoms, particularly when delivered by a doctor who specializes in fibromyalgia. A comprehensive treatment approach that combines medication with non-drug approaches has been shown to be the most effective course of care and improve overall well-being.

In this article, we’ll explore the most commonly prescribed fibromyalgia medications, how they work, the clinical evidence supporting their use, and what you need to know when discussing treatment options with your doctor to find an effective treatment plan for you.

Fibromyalgia Medication List

Fibromyalgia medications can be categorized into several classes based on their mechanism of action. These include pain relievers, antidepressants, anticonvulsants, and muscle relaxants. These medications are often used in combination to address fibromyalgia’s primary symptoms: pain, fatigue, cognitive function, and mood.

Let’s take a closer look at each category and the specific drugs used in fibromyalgia treatment, of which three are approved by the Food and Drug Administration (FDA) specifically for fibromyalgia (pregabalin, duloxetine, and milnacipran).

Keep in mind that this list is not inclusive of all medications that are used for fibromyalgia. Other medications, particularly those with similar profiles to those listed here, may be used for fibromyalgia symptoms; always check with your doctor to discuss new medications or changes. 

Over-the-Counter Pain Relievers

Acetaminophen (Tylenol)

When people are first experiencing fibromyalgia pain and flares, over-the-counter pain relievers are often a first-line option. Acetaminophen is a commonly used pain reliever that can help manage mild to moderate pain associated with fibromyalgia. It works by inhibiting pain signals in the brain, but does not address the underlying cause of pain.

Studies suggest that acetaminophen is generally effective for mild pain, but it is often not sufficient for more severe fibromyalgia pain. A study published in the Journal of Clinical Rheumatology found that acetaminophen provided limited relief for fibromyalgia patients compared to other medications, including antidepressants or anticonvulsants [1]. 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

You’re likely also familiar with this class of drugs since they are so commonly used: NSAIDs like ibuprofen (Advil) and naproxen (Aleve) reduce inflammation and pain. Although inflammation has not been shown to be a primary driver of fibromyalgia in clinical studies, these drugs may still be helpful for some patients in managing musculoskeletal pain.

However, research also shows mixed results for NSAIDs in treating fibromyalgia. A Cochrane review found that NSAIDs provided modest pain relief for people with fibromyalgia, but were not particularly effective compared to other treatments [2].

Common Side Effects

• Stomach upset
• Heartburn 
• Headache

Less Common Side Effects

• Stomach ulcers or bleeding
• Kidney strain
• Elevated blood pressure
• Heart risk with long-term use

Anticonvulsants

Anticonvulsants, or anti-seizure medications, are commonly used to treat nerve-related pain. They are often prescribed to fibromyalgia patients because of the underlying basis in the central nervous system, known as central sensitization. This class of drugs works to “correct” some of the heightened pain processing signals that fibromyalgia patients experience.

Pregabalin (Lyrica)

Pregabalin works by inhibiting the release of neurotransmitters involved in pain transmission signals in the brain. It was the first medication specifically approved by the FDA for the treatment of fibromyalgia, making it one of the most widely prescribed medications for fibro.

Pregabalin’s efficacy in treating fibromyalgia was established in a 2008 study published in The Lancet, which demonstrated a significant reduction in pain and improvements in function [3]. Subsequent trials have confirmed its benefit; pregabalin was found to significantly reduce pain and improve physical functioning in fibromyalgia patients. 

However, some people experience side effects like dizziness and fatigue when taking pregabalin, which can limit its use. Finding a healthcare provider experienced in pregabalin can help patients find an individualized dose if medically beneficial.

Common Side Effects

• Dizziness
• Drowsiness
• Weight gain
• Peripheral edema (swelling of hands and feet)
• Blurred vision
• Dry mouth
• Cognitive difficulties/”brain fog”

Less Common Side Effects

• Balance problems or ataxia (increased fall risk) 
• Increased appetite 
• Mood changes, including depressive symptoms or rare suicidal ideation — report any worsening mood or suicidal thoughts to a clinician immediately 
• Withdrawal symptoms if stopped suddenly

Gabapentin (Neurontin)

Gabapentin is the other most commonly used anticonvulsant for fibromyalgia. Like pregabalin, It works by altering the way the brain processes pain signals. A 2007 study published in Arthritis and Rheumatology found that gabapentin can be moderately effective for treating pain as well as improving sleep in fibromyalgia patients [4]. 

However, some patients do also find similar side effects to pregabalin, including dizziness and trouble concentrating (which is also a fibromyalgia symptom to begin with). 

Common Side Effects

• Drowsiness
• Dizziness
• Weight gain
• Leg swelling
• Fatigue

Less Common Side Effects

• Cognitive problems/brain fog
• Clumsiness or balance issues 
• Mood changes
• Withdrawal symptoms if stopped suddenly

Antidepressants

Antidepressants are some of the most-commonly prescribed medications for fibromyalgia; in fact, two of the three FDA approved medications for fibromyalgia treatment are in this category. If you have fibromyalgia, this can be extremely frustrating and even gaslighting: If fibromyalgia is not in my head, why is my doctor prescribing an antidepressant?

However, stay with us: these fibromyalgia medications not only help treat the mental health effects of living in chronic pain, but also can have a chemical effect on how the brain regulates pain. Read on to learn more about how they work. 

Duloxetine (Cymbalta)

Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that helps increase levels of neurotransmitters called serotonin and norepinephrine in the brain. These neurochemicals play a crucial role in how the brain regulates pain responses, so it makes sense that increasing them can help moderate the pain response in people with fibromyalgia. 

Multiple clinical trials have demonstrated the effectiveness of duloxetine in fibromyalgia treatment. A multicenter study published in Arthritis and Rheumatology found that duloxetine significantly reduced pain and improved quality of life in fibromyalgia patients compared to a placebo [5]. The drug is FDA-approved for fibromyalgia and is considered a first-line treatment.

Common Side Effects

• Nausea (most common) 
• Dry mouth 
• Fatigue or drowsiness 
• Increased sweating 
• Constipation 
• Loss of appetite or mild weight loss

Less Common Side Effects

• Elevated blood pressure
• Sexual dysfunction
• Withdrawal symptoms if stopped suddenly
• Rare liver enzyme elevation

Milnacipran (Savella)

Milnacipran is another SNRI that is specifically approved for the treatment of fibromyalgia. It works similarly to duloxetine, but has a stronger effect on norepinephrine, which can be particularly helpful for reducing pain.

A 2008 study published in Clinical Therapeutics found that milnacipran reduced pain and fatigue in fibromyalgia patients [6]. Milnacipran was FDA-approved for fibromyalgia in 2009 based on these findings.

Common Side Effects

• Nausea
• Headache 
• Sweating 
• Constipation 
• Rapid heartbeat or palpitations

Less Common Side Effects

• Elevated blood pressure 
• Insomnia 
• Urinary hesitancy 
• Withdrawal symptoms if stopped suddenly

Amitriptyline (Elavil)

Amitriptyline is a tricyclic antidepressant (TCA) that is often prescribed off-label for fibromyalgia. It also works by increasing levels of serotonin and norepinephrine, as well as has sedative properties, which can help with the sleep disturbances that come with fibromyalgia.

A systematic review in the Cochrane Database found that amitriptyline can be effective in reducing pain and improving sleep in fibromyalgia patients, though its side effects (such as weight gain and dry mouth) may limit its use [7]. In addition, those sedative side effects that can help with sleep also make it less ideal for daytime use.

Common Side Effects

• Dry mouth 
• Drowsiness
• Constipation 
• Weight gain

Less Common Side Effects

• Low blood pressure or dizziness when standing 
• Blurred vision 
• Heart rhythm irregularities (rare at low doses)

Selective Serotonin Reuptake Inhibitors (SSRIs)

While SSRIs are widely used for depression and anxiety, they are not FDA-approved for fibromyalgia and are less effective for pain reduction than SNRIs (like duloxetine or milnacipran). However, patients frequently ask about them, and they may be considered in patients where significant depression is a primary symptom, or when they cannot tolerate other antidepressants more commonly used for fibromyalgia. 

Examples of SSRIs include fluoxetine (Prozac), paroxetine (Paxil) and citalopram (Celexa) They may be considered in fibromyalgia patients who have significant comorbid depression or anxiety and cannot tolerate SNRIs or tricyclics. 

A Cochrane review of SSRIs for fibromyalgia found: “No unbiased evidence that SSRIs are superior to placebo for pain, fatigue, or sleep.” Modest improvements in mood symptoms, but limited impact on core fibromyalgia symptoms. Because of this, SSRIs are not considered first-line therapies for fibromyalgia pain. [8]

Common Side Effects

• Nausea 
• Sexual dysfunction 
• Weight gain 
• Insomnia or excessive sleepiness 
• Anxiety or restlessness

Less Common Side Effects

• Sweating 
• Withdrawal symptoms if stopped abruptly 
• Serotonin syndrome when combined with other antidepressants

Muscle Relaxants

Muscle relaxants are sometimes prescribed to help manage the muscle spasms and stiffness associated with fibromyalgia. These fibromyalgia medications can provide relief by relaxing the muscles and reducing pain.

Cyclobenzaprine HCI (Tonmya) — Newly FDA-Approved

Tonmya is the newest FDA-approved fibromyalgia medication—and the first fibromyalgia-specific approval in more than 15 years. Approved on August 15, 2025, Tonmya offers a reformulated version of cyclobenzaprine designed specifically for fibromyalgia. 

Cyclobenzaprine is a muscle relaxant with some structural similarities to tricyclic antidepressants. They work by blocking several receptors in the brain and nervous system, including those that cause muscles to contract. Unlike traditional cyclobenzaprine tablets, Tonmya is a sublingual (under-the-tongue) medication. Taking the medication this way helps bypass “first-pass metabolism,” a process where a significant portion of drug is metabolized in the gut wall and liver, reducing the amount of active drug that reaches the bloodstream. That means patients can get more effect from lower doses

Tonmya was evaluated in two major Phase 3 trials, where it demonstrated statistically significant reductions in pain scores, sleep quality, fatigue, and patient global impression of change (PGIC). Because Tonmya is specifically engineered for bedtime use, its sedating effects are typically aligned with sleep rather than daytime fatigue.

Common Side Effects

• Oral numbness or tingling
• Drowsiness or sedation
• Abnormal or bitter taste
• Dry mouth
• Fatigue
• Headache

Less Common Side Effects

• Oral numbness or tingling
• Drowsiness or sedation
• Abnormal or bitter taste
• Dry mouth
• Fatigue
• Headache

Cyclobenzaprine (Flexeril)

Before Tonmya, cyclobenzaprine was used off-label for the treatment of fibromyalgia as a muscle relaxant. It is still used in many cases to address muscle stiffness and spasms.

Clinical studies have shown that cyclobenzaprine can help with fibromyalgia-related muscle pain and stiffness. A meta-analysis published in Arthritis and Rheumatology found that cyclobenzaprine provided significant improvements in pain, sleep, and muscle tension in people with fibro [9].

Common Side Effects

• Sedation and drowsiness
• Dry mouth 
• Dizziness 
• Fatigue

Less Common Side Effects

• Confusion or grogginess 
• Serotonin syndrome when combined with other antidepressants

Tizanidine (Zanaflex) 

Tizanidine is a muscle relaxant used off-label for fibromyalgia, particularly for patients struggling with muscle tightness, spasms, or sleep disruption. It works by reducing the release in the brain of substance P—a key neurotransmitter involved in amplifying pain signals. By decreasing substance P activity, tizanidine can help reduce the heightened pain sensitivity seen in fibromyalgia.

Although tizanidine is not FDA-approved for fibromyalgia, studies have shown that it can not only improve pain but also fatigue and sleep quality, particularly when taken at night. [10]

Common Side Effects

• Drowsiness
• Dry mouth 
• Dizziness 
• Weakness or fatigue 
• Low blood pressure (lightheadedness)

Less Common Side Effects

• Liver enzyme elevation 
• Depression or mood changes (rare) 
• Rebound hypertension if stopped abruptly

Other Medications

In some cases, other medications may be prescribed based on an individual’s specific symptoms.

Low Dose Naltrexone (LDN)

In recent years, low dose naltrexone (LDN) has gained attention as a promising treatment option for fibromyalgia, particularly for those who don’t respond well to traditional fibromyalgia meds. 

LDN is believed to work by temporarily blocking opioid receptors in the brain, which stimulates the production of endorphins. This brief “blockage” is followed by a surge in endorphins, the body’s natural pain-relieving chemicals. Naltrexone is typically used in much higher doses in most medical settings, but in low doses (typically 1-5 mg per day), it has been found to have immune-modulating effects and may help alleviate fibromyalgia symptoms. [11]

Increased endorphin levels may help reduce pain, improve sleep, and enhance mood. That’s one reason why people with fibromyalgia are often given advice to move, even when that can be challenging. 

A 2013 study published in Arthritis and Rheumatology found that LDN significantly reduced pain and improved quality of life in fibromyalgia patients [12]. In another study, The Clinical Rheumatology Journal in 2014, LDN showed promise in reducing pain and fatigue in fibromyalgia patients who had not found relief from conventional treatments [13].

LDN is not FDA-approved for fibromyalgia, but it has become increasingly popular as an off-label treatment, particularly for those seeking a more holistic or alternative approach.

Common Side Effects

• Vivid dreams 
• Sleep disturbances (insomnia or restlessness) 
• Headache 
• Mild nausea

Less Common Side Effects

• Temporary symptom flare during first 1–2 weeks 
• Rare anxiety or irritability

Corticosteroids

Corticosteroids are a class of steroid hormones that can reduce inflammation. They mimic cortisol, a hormone naturally produced by the adrenal glands, and help control inflammation and pain. 

While fibromyalgia is not an inflammatory condition in the traditional sense, corticosteroids are sometimes used for short-term flare-ups of pain or other inflammatory-related symptoms, particularly in patients with other co-occurring inflammatory conditions like rheumatoid arthritis. However, there is a lack of evidence that this is an effective treatment for fibromyalgia, and due to the risk of side effects, such as weight gain, osteoporosis, and immune suppression, corticosteroids are generally used sparingly in fibromyalgia treatment.

Magnesium

Although considered a supplement and not a medication, magnesium plays a role in muscle relaxation, nerve function, and the regulation of pain, making it a potentially beneficial treatment for fibromyalgia patients as part of diet and supplement guidance. 

Magnesium helps regulate muscle contractions and nerve impulses, which may reduce the muscle spasms and nerve pain often experienced by fibromyalgia patients. It also plays a role in modulating the body’s response to stress, which can alleviate some of the anxiety and sleep disturbances associated with fibromyalgia.

Several studies have suggested that magnesium supplementation may improve fibromyalgia symptoms. A 2009 study in The Journal of Nutritional Medicine found that magnesium levels were significantly lower in fibromyalgia patients compared to healthy controls [14]. A 2022 study published in Nutrients showed that magnesium supplementation improved pain, fatigue, and sleep disturbances in fibromyalgia patients [15]. While magnesium is not a cure, it can provide symptom relief, particularly when combined with other treatments.

How to Choose the Right Fibromyalgia Medication

Choosing the right fibromyalgia medications depends on a variety of factors, including:

• Symptom Severity: Medications like duloxetine or pregabalin are often preferred for patients with moderate to severe symptoms, while mild cases may benefit from over-the-counter pain relievers.
• Side Effect Profile: Side effects like dizziness, weight gain, or sedation can impact a patient’s choice of medication. Discuss these factors with your doctor.
• Co-existing Conditions: If you have other conditions like depression or anxiety, medications like SNRIs may offer dual benefits for both pain and mood regulation.

Always consult with your doctor before starting, stopping, or adjusting any medications for fibromyalgia to ensure the best possible outcomes. 

FAQ about Fibromyalgia Medication

What is the best pain reliever for fibromyalgia?

There isn’t a single “best” painkiller for fibromyalgia, as response varies by individual. The FDA has approved three primary medications for fibromyalgia pain: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella), plus the newly approved Tonmya. Traditional painkillers like acetaminophen typically provide limited relief. Your doctor can help determine which medication may work best for your specific symptoms.

What is the best muscle relaxer for fibromyalgia?

Cyclobenzaprine (Flexeril) is the most studied muscle relaxer for fibromyalgia, with research showing it can help with pain, sleep, and muscle tension. Tizanidine (Zanaflex) is another option that may reduce substance P levels and improve sleep when taken at bedtime. The newly-approved Tonmya is a sublingual form of cyclobenzaprine specifically designed for fibromyalgia. Note that other muscle relaxers, besides Tonmya, are generally used off-label for fibromyalgia.

What is the new medication for fibromyalgia in 2025? 

The newest FDA-approved medication for fibromyalgia is Tonmya, a low-dose sublingual formulation of cyclobenzaprine designed specifically for fibromyalgia. Approved on August 15, 2025, Tonmya is the first new fibromyalgia treatment in more than 15 years. It is taken once nightly and was shown in Phase 3 trials (RELIEF and RESILIENT) to significantly reduce pain, improve sleep quality, and enhance overall symptom burden.

Can you take multiple fibromyalgia medications together? 

Yes, many fibromyalgia patients benefit from combination therapy, especially when symptoms are complex. For example:

• An SNRI for mood and pain 
• Gabapentin or pregabalin for neuropathic pain 
• A bedtime medication like a tricyclic or tizanidine for sleep and muscle tension 

These medications work on different pathways involved in fibromyalgia (pain processing, sleep regulation, neural hyperexcitability), and combining them can improve outcomes. However, combinations should always be advised and prescribed by a clinician to reduce side effects, interactions, or duplicate mechanisms.

What medications should fibromyalgia patients avoid?

Some medications are not recommended for fibromyalgia symptoms alone, because research has now shown significant benefit or because they carry higher risk:

• Opioids – Not shown to be effective for fibromyalgia pain and can worsen pain sensitivity over time, as well raise dependence risk.
• Benzodiazepines (e.g., clonazepam, alprazolam) – Can worsen fatigue, impair cognition, and raise dependence risk. 
• Chronic corticosteroids – No evidence they improve fibromyalgia symptoms and can cause significant side effects. 
• NSAIDs alone – Safe for short-term use but generally not effective for fibromyalgia pain. 
• Tramadol – Sometimes used but increasingly discouraged due to dependence potential and limited long-term benefit

Patients should always review their medication list with a clinician, especially if they’re taking multiple sedating drugs or medications for other conditions.

What is the first-line treatment for fibromyalgia? 

Guideline-directed treatment typically includes a combination of approaches, also called multimodal care. This may include:

• Evidence-based medication management
• Personalized movement, tailored to chronic pain reduction
• Behavioral therapies, like cognitive behavioral therapy or acceptance and commitment therapy
• Sleep and fatigue management

Summary

Fibromyalgia medications can play a crucial role in managing the symptoms of this chronic condition, but finding the right treatment often requires trial and error. From pain relievers and antidepressants to anticonvulsants and muscle relaxants, there are a variety of options available, each with its own mechanism of action and evidence supporting its use. 

Fibromyalgia is a complex condition that requires a multifaceted treatment approach. In addition to medications, non-pharmacological therapies such as physical therapy, cognitive behavioral therapy (CBT), acupuncture, and tailored movement programs can also help manage fibromyalgia symptoms. 

Many patients find that a combination of medication and lifestyle changes is the most effective approach. By working closely with a fibromyalgia specialist like Swing Care, you can develop a comprehensive treatment plan tailored to your specific needs. With the right combination of treatments, it’s possible to improve your quality of life and help manage the challenges of fibromyalgia.

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