Understanding Fibromyalgia; How Experts are Diagnosing and Treating Their Patients - Episode 13
Experts offer their clinical experience discussing how they utilize off label drugs in the treatment of fibromyalgia (FM).
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Any other we've talked a lot about our off-label meds. Before we transition over to the on-label FDA approved drugs for fibromyalgia, we talked about amitriptyline, cyclobenzaprine, memantine, we've talked about opioids, NSAIDs, we've talked about low dose naltrexone. Is anyone using anything else? Are any of you doing a stimulant for daytime sedation? Natelson.
Benjamin Natelson, MD: I use a stimulant all the time in treating chronic fatigue patients. But while we're still on pain, Wendy, there are there's one study in past that's along covid where low doses of aripiprazole are helpful, and I have tried it. And I'm I anecdotally again, Dan my practice is all anecdotal I have been terribly impressed, another treatment which is expensive but there are 2 papers in FM is hyperbaric oxygen and if a patient if there's a facility and a patient can figure out the finances those papers were relatively convincing. It should be considered.
Kostas Botsoglou, MD: For a very limited group of patients. I have you used,
Benjamin Natelson, MD: What for?
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I'm sorry. What was that comment that you made? Dr. Botsoglou?
Kostas Botsoglou, MD: For a very small group of patients I have used benzodiazepine especially help them with sleep and relaxations.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: I don't know if any of you are using the orexin antagonist, but I've had some good luck with the orexin antagonist in turning off that wakefulness center as well. I've had in that way I don't have to worry as much combining it with other agents. I think a lot of these agents too have QT prolonging effects. And that stackable QT effect is something that we all must be cognizant of.
Benjamin Natelson, MD: And I've just prescribed one and the insurance company said no, you need to try one of the other sedatives first. And I would rather use the orexin related drug, but that's the way it is.
Wendy Wright, DNP, ANP-BC, FNP-BC, FAANP, FAAN, FNAP: Me too. You generally have to fail I think two agents in order approval for them which is often zolpidem or one of the Z drugs.
Transcript edited for clarity.