Benefits of duloxetine and milnacipran in fibromyalgia seem to be outweighed by harm

Only a minority of people with fibromyalgia may enjoy relief of their symptoms without adverse events when using serotonin and noradrenaline reuptake inhibitors called duloxetine and milnacipran, says a large review of the evidence.

Fibromyalgia is characterised by chronic widespread pain that often co-exists with sleep disturbances, cognitive dysfunction and fatigue. People with fibromyalgia report high disability levels and poor quality of life.

Drug therapy with serotonin and noradrenaline reuptake inhibitors aims to reduce key symptoms and improve quality of life.

Experts have looked at the safety of serotonin and noradrenaline reuptake inhibitors compared with placebo or other active drug(s) in the treatment of fibromyalgia in adults and whether the drugs work. Data from 7,903 people was analysed.

“The potential benefits of duloxetine and milnacipran in fibromyalgia were outweighed by their potential harms,” the authors conclude. “However, a minority of people with fibromyalgia might experience substantial symptom relief without clinically relevant adverse events with duloxetine or milnacipran.”

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