Rheumatology Medical News about Fibromyalgia, Duloxetine, SNRI

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Duloxetine for the management of fibromyalgia syndrome
Journal of Pain Research, 07/24/09

Scholz BA et al. – This review focuses on the use of duloxetine in fibromyalgia syndrome (FMS) management and includes informationon on pharmacology and pharmacokinetics, a review of the 3 duloxetine FMS treatment trials currently in publication, a discussion of the safety and tolerability of duloxetine, and patient focused perspectives on duloxetine use in FMS management.

FMS is a complex disorder best managed by pharmacologic and nonpharmacologic treatments
FMS symptoms: Fatigue, Insomnia, Blues, Rigidity, and pain
Duloxetine is indicated for the management of adult FMS pts at a dose of 60 mg once daily
However, lower doses may be effective; a 20 mg once daily dose with increases in weekly intervals only if needed
Pain ameliorating effect of duloxetine is independent of its effect on mood, however should be the first line therapy in FMS pts with coexisting mood disorders
Duloxetine may be particularly beneficial in FMS pts with significant cognitive dysfunction, but it may worsen symptoms of Fatigue and Insomnia
TEAEs seen in duloxetine trials include nausea, drymouth, vomiting, decreased appetite, constipation, insomnia, dizziness, fatigue, somnolence, and adversesexual side effects
Duloxetine may increase suicide risk, particularly in younget pts
Duloxetine use has been associated with liver function test abnormalities and hyponatremia; pts should be counseled to avoid alcohol use
Duloxetine should be used with caution in pts with pre-existing cardiovascular disease and/or increased bleeding risk

Exclusive Author Commentary
Chad S Boomershine, 07/24/09

My coauthors and I are honored that MDLinx has chosen to highlight our article. Fibromyalgia syndrome (FMS) can be a very challenging condition to treat. Due to the complexity of FMS, the editors of the Journal of Pain Research requested this article to better clarify the role of duloxetine in managing FMS. We hope readers find the article helpful. However, FMS patients often require a multi-dimensional treatment approach that utilizes multiple pharmacologic and non-pharmacologic therapies. For a more general review of pharmacologic FMS management, we recommend "Boomershine CS and Crofford L. (2009) A Symptom-Based Approach to Pharmacologic management of Fibromyalgia. Nature Reviews Rheumatology 5(4), 191-9." Please contact me if you have any questions or comments from either article chad.boomershine@vanderbilt.edu. Thank you.

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