Home > Health Library > Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) for Fibromyalgia
SNRIs work to increase the activity of
brain chemicals called serotonin and norepinephrine. Doctors do not know
exactly how this improves
Doctors may prescribe serotonin and
norepinephrine reuptake inhibitors (SNRIs) when mood problems are a major
symptom of fibromyalgia. SNRIs are also used for people without fibromyalgia
Some people with fibromyalgia who
take SNRIs notice an improvement in a number of symptoms, including depression,
pain, and fatigue. But it's hard to tell if SNRIs will work for you and how much they will help. A review of studies showed a small improvement in pain. But the same review showed no improvement in sleep problems for people taking the medicine.1
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor right away if you have:
Common side effects of these medicines include:
The U.S. Food and
Drug Administration (FDA) has issued:
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems.)
Never suddenly stop taking SNRIs. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse of your condition.
SNRIs are started at low doses, and the dose is increased gradually to reduce the severity of side effects. You may need regular blood tests to check the amount of the medicine in your blood. Too much of this type of medicine in the bloodstream can be dangerous.
Treatment with antidepressants does
not always relieve symptoms caused by fibromyalgia. Even when the treatment
does work, some people may find the side effects of these medicines
Using an antidepressant medicine to treat
fibromyalgia does not mean that the condition is "all in your head."
Be sure to tell your doctor about all the medicines you are currently taking. Duloxetine and milnacipran can interact poorly with monoamine oxidase (MAO) inhibitors (taken for depression and other mental health conditions). Examples of MAO inhibitors include phenelzine, selegiline, and tranylcypromine.
Duloxetine can affect blood sugar levels in people with diabetes. If you notice that the results of your blood sugar tests are different than you expect, or if you have any questions, talk to your doctor.
makes bleeding more likely in the upper gastrointestinal tract (stomach and
esophagus). Taking venlafaxine with NSAIDs (such as Aleve or Advil) makes
bleeding even more likely. Taking medicines that control acid in the stomach
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Häuser W, et al. (2013). Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database of Systematic Reviews (1).
Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper
gastrointestinal tract bleeding associated with selective serotonin reuptake
inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
October 10, 2013
Anne C. Poinier, MD - Internal Medicine & Karin M. Lindholm, DO - Neurology
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