Treatment for fibromyalgia is usually a combination of lifestyle adjustments, like making changes to get more sleep and exercise regularly, a form of talk therapy known as cognitive behavioral therapy (CBT), and medication. The drugs used to help manage fibromyalgia may help address different symptoms, such as:
- Pain
- Fatigue
- Low mood or depression
- Insomnia or restlessness
Over-the-counter and prescription painkillers, such as NSAIDs, opioids and corticosteroids, are typically not very effective in managing fibromyalgia pain. There are four drugs approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of fibromyalgia, including:
- Pregabalin (Lyrica): This is the first drug approved by the FDA for fibromyalgia. This medication was originally approved to manage epilepsy. It belongs to a class of drugs called gabapentinoids that are used to control seizures and manage nerve pain. It works by slowing down impulses in the brain that cause seizures, or calming overactive nerves involved in pain and anxiety. It is also used to treat nerve pain in people with diabetes, shingles, or spinal cord injuries. And in 2007, it was approved for fibromyalgia.
- Duloxetine (Cymbalta): This medication belongs to a group of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs), which are used to treat depression and anxiety. Duloxetine, however, is also approved to treat fibromyalgia pain and stiffness as well as pain tied to nerve damage from diabetes. It works by increasing levels of serotonin and norepinephrine, which are two brain chemicals that help regulate mood and pain signals
- Milnacipran (Savella): Milnacipran is another SNRI approved to treat fibromyalgia. Like duloxetine it works by increasing serotonin and norepinephrine levels in the brain to help ease fibromyalgia pain, fatigue, and brain fog.
- Cyclobenzaprine hydrochloride (HCl) (Tonmya): In 2025, this medication became the fourth drug to be FDA-approved for fibromyalgia. It is a nonopioid painkiller and muscle relaxant, which means it is not a narcotic like oxycodone, codeine, morphine, and others. This is a tablet that is placed under the tongue, so it is absorbed by the body quickly and is not metabolized in the liver. Cyclobenzaprine HCl can help manage widespread pain as well as other fibromyalgia symptoms, including fatigue and poor sleep.
Other “off label” fibromyalgia medications
There are other drugs used by healthcare providers (HCP) to help ease fibromyalgia symptoms—even though they aren’t specifically FDA-approved to treat fibromyalgia. These are called “off-label” medications.
It’s important to take a strategic approach by working closely with your healthcare provider (HCP) so you can monitor, modify, and fine-tune your treatment plan. Here are some of the medications that may prescribe to address fibromyalgia pain, poor sleep, and low mood or depression:
Gabapentinoids: In addition to pregabalin (Lyrica), other drugs in this group may be used to help treat fibromyalgia. For example, another medication in this class called gabapentin, which is usually used to manage nerve pain, is also sometimes used to improve sleep and manage restless leg syndrome, which often occurs in those with fibromyalgia.
Tricyclic antidepressants (TCAs): These drugs, such as amitriptyline (Elavil), are antidepressants that can also improve pain symptoms. They can help ease depression as well as nerve pain.
Sleep aids: There are several medications that may be used to help manage poor sleep or insomnia, including zolpidem (Ambien, Ambien CR, Edluar, Intermezzo). Diphenhydramine (Benadryl) is also an antihistamine that can make you sleepy. And for some, a melatonin supplement may also help. Improving sleep can, in turn, help improve energy levels, pain perception, and mental clarity.
Selective serotonin reuptake inhibitors (SSRIs): These drugs, such as fluoxetine (Prozac, Sarafem), paroxetine (Brisdelle, Paxil, Pexeva) and sertraline (Zoloft), are used to help treat depression. SSRIs are generally less helpful for fibromyalgia pain than SNRIs but they could help people with fibromyalgia who develop low mood or depression related to their condition.
Sources: Farag HM, Yunusa I, Goswami H, et al. Co... + 9
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