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Medication generic/trade

Common dosage

FM usage


0.25-3 mg/day

Panic attacks


10-50 mg at hs in single dose

Mild Pain, sleep


7.5 mg at hs


Bupropion Hydrochloride/Wellbutrin*

Slow release 150-300 mg SR bid or 300 XL qd

Fatigue, fibro fog

Carbidopa, Levodopa/Sinemet*

10/100-20/200, 1 tab hs

Restless leg syndrome


350 mg, 1-4 times per day

Muscle relaxation, pain

Clonazepam/Klonopin, Clonapam*

0.25-2 mg hs, tabs or quick dissolving wafer for faster onset of action and potentially lower total dosing

Anxiety, Restless leg syndrome, sleep


5-30 mg at hs

Muscle relaxation, mild pain, sleep


30-120 mg in 24 hrs

Pain. Adjunct to Ultram/ Ultracet before moving to scheduled opioids

Dicyclomine hydrochloride/Bentyl *

20 mg oral qid

Irritable bowel syndrome/pain

Duloxetine hydrochloride/ Cymbalta

20-120 mg per day

depression, sleep, pain



2-4 mg at hs



Ethyl chloride, fluorimethaneÒ spray - termed Spray and Stretch*

Dependant upon body region affected and severity

Muscle pain and myofascial pain syndrome

Fentanyl citrate/Actiq*

200 mcq transmucosal

Irritable bowel syndrome/severe pain



0.1 mg

Adjunct to treating neurally mediated hypotension (NMH),

Sodium oxybate/Xyrem

4.5-6 mg at hs, repeat 3-4 hours later if needed




900-3600 mg/day in 3 divided doses

Neuropathic pain


Growth Hormone (e.g., Nutropin)

Values dependent on serum Insulin like Growth Factor levels and body weight. Daily sub-q injections required.

Depression, fatigue, pain, quality of life

Hydrocodone bitartrate/Vicodin

(One of several short acting narcotics)*

Varies with half-life of drug selected and pain level

Moderate Pain

Lidocaine/Lidoderm Patch

Patch can be applied directly to FM trigger points. Lidocaine can be directly injected in trigger points.

Myofascial pain syndrome


2-4 mg initially, up to 16 mg in 24 hours

Mild IBS diarrhea prone


2-10mg up to qid

Sleep, anxiety, muscle relaxation, restless leg syndrome


5-20 mg bid

Moderate to severe chronic pain


200-400 mg q am

Severe daytime fatigue and sleepiness. May help fibro fog in some patients.

MS Contin/Kadian*

15-60 mg bid

Moderate to severe chronic pain

Non-steroidal Anti-inflammatory agents (NSAIDs)

Depends on agent chosen

Chronic headaches, tendonitis, concurrent osteoarthritis

Oxycodone/Percocet, Percodan*

Varies with half-life of drug selected and pain level

Moderate Pain

Oxycodone hydrochloride /Oxycontin*

10-30 mg bid

Moderate to severe chronic pain

Pramipexole dihydrochloride/Mirapex

0.125-1.5 mg at dinnertime,

Restless leg syndrome


450 mg divided bid

Fatigue, pain, sleep


Pyridostigmine bromide/Mestinon

60 mg-180 mg time span bid

Normalize growth hormone response to exercise.

Roprinirole hydrochloride/Requip

0.5-5 mg at dinner time

Restless leg syndrome

SSRI (selective serotonin reuptake inhibitors - several in this class), those tested in FM, fluoxetine  citalopram hydrobromide/Celexa sertraline hydrochloride/ Zoloft

Depends on agent chosen


 +/- Anxiety

Tegaserod maleate/Zelnorm*

6 mg bid before breakfast and after dinner.

Irritable bowel syndrome, constipation type

Tiagabine HCl/Gabitril*

4 - 56 mg/day given in 2-4 divided doses

Neuropathic pain, sleep

Tizanidine hydrochloride/Zanaflex

4-8 mg hs

Muscle relaxation, mild pain, sleep, stiffness



Migraine prophylaxis indication, side effects fatigue & rash

Tramadol hydrochloride with Acetaminophen/ Ultracet

37.5 mg every 4-8 hours not to exceed 8 in 24 hours

Mild to Moderate Pain

Tramadol hydrochloride/Ultram

50-100 mg every 4-8 h, not to exceed 400 mg in 24 hours

Mild to Moderate Pain

Transdermal Fentanyl (Duragesic Patch)*

25 mcg/hr change q 3 days

Moderate to severe chronic pain

Trazadone Hydrochloride/Desyrel, Trazon, Trialodine

50-150 mg/day hs

Depression, sleep


10 mg hs





100-400 mg q hs only to minimize side effects of fatigue and dizziness when taken in the daytime

Neuropathic pain



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