Pharmacotherapy of Fibromyalgia: Focus on Duloxetine

E. Serra, M. Andréjak
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Abstract

Context: Fibromyalgia syndrome (FMS) is a frequent medical condition characterized by chronic widespread pain and reduced pain threshold. Associated symptoms include fatigue, non restorative sleep, and psychological distress. As usual in medicine, even if the pathogenesis is unclear, some treatments are useful to help patients. Objectives: Tricyclic antidepressants were the first drugs used to treat FMS. More recently, among serotonin-norepinephrine reuptake inhibitors, duloxetine was approved by US Food and Drug Administration to treat FMS. Duloxetine is used for the management of major depressive disorder, neuropathic pain, generalized anxiety disorder, and stress incontinence. In the pharmacotherapy of fibromyalgia, a focus is presented on the drug duloxetine. Results: Mechanism of action, metabolism and pharmacokinetic profile are presented. Clinical studies of Duloxetine showed an acceptable efficacy for this chronic condition: Number Need to Treat (NTT) of 4.7 to 9.9, through two 3-month placebo-controlled trials and two 6-month trials. Evaluation criteria are discussed. Safety of this medication has been found to be satisfactory, with nausea as the most common adverse event, in almost 20% of cases. Conclusion: Treatment algorithm for duloxetine is presented inside FMS treatment strategy. With duloxetine, it is important to start low and increase slowly to prevent or minimize adverse events: 30 mg/day up to 60 mg/day in the second week and if necessary up to 90–120 mg/day. It is possible to treat for 3 to 6 months, possibly up to 12 months. The drug could be decreased 2 to 4 weeks before stopping, with regular assessments during this time. International recommendations insist on multimodal treatments: drug and non drug. Also effective for anxiety and depression, duloxetine ranks among the first place drugs for FMS.
纤维肌痛的药物治疗:以度洛西汀为主
背景:纤维肌痛综合征(FMS)是一种常见的医学病症,其特征是慢性广泛性疼痛和痛阈降低。相关症状包括疲劳、非恢复性睡眠和心理困扰。通常在医学上,即使发病机制尚不清楚,一些治疗方法对帮助患者是有用的。目的:三环类抗抑郁药是治疗FMS的首选药物。最近,在5 -羟色胺-去甲肾上腺素再摄取抑制剂中,度洛西汀被美国食品和药物管理局批准用于治疗FMS。度洛西汀用于治疗重度抑郁症、神经性疼痛、广泛性焦虑症和应激性尿失禁。在纤维肌痛的药物治疗中,重点介绍了药物度洛西汀。结果:介绍了其作用机制、代谢和药动学特征。临床研究表明,度洛西汀对这种慢性疾病的疗效是可以接受的:通过两个为期3个月的安慰剂对照试验和两个为期6个月的试验,需要治疗的数量(NTT)为4.7至9.9。讨论了评价标准。该药物的安全性令人满意,在近20%的病例中,恶心是最常见的不良事件。结论:在FMS治疗策略中给出了度洛西汀的治疗算法。对于度洛西汀,重要的是低剂量开始并缓慢增加,以防止或减少不良事件:第二周30毫克/天至60毫克/天,必要时可达90-120毫克/天。有可能治疗3到6个月,也有可能长达12个月。可在停药前2至4周减少剂量,并在此期间进行定期评估。国际建议坚持多模式治疗:药物和非药物。度洛西汀对焦虑和抑郁也有效,是治疗FMS的首选药物之一。
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