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The UKFibromyalgia Forums • View topic - Cymbalta/Duloxetine - Any good for fibro?



Cymbalta/Duloxetine - Any good for fibro?

All your questions and experiences of medication and treatments on the NHS or Private Healthcare.

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Cymbalta/Duloxetine - Any good for fibro?

Postby paulfoel » Fri Jun 19, 2015 12:56 pm

Wife just started taking this as an offlabel for fibro.

Currently she takes cocodamol, gabapentin etc but not really too effective.
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby migrembe » Fri Jun 19, 2015 9:53 pm

I can't gabapentin or pregabalin so Gp started me on Duloxetine and it's really helped. I also cocodamol too. I am not pain free, but pain less-er.
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby paulfoel » Mon Jun 22, 2015 1:06 pm

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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby cdcrossy » Mon Jun 22, 2015 1:37 pm

I'm on gabapentine,tramadol and duloxetine and i was having pains before i was given the duloxetine and now I'm better with it i only take one at night but it has helped a lot
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby TheHud » Mon Jun 22, 2015 1:45 pm

Hubby uses gabapentine in the hospital because it is out from licence restrictions and generic drugs exist, it is cheap as chips now. However that is for short term acute pain, for long term he asked the doc for Pfizer Pregablin for me, because it has fewer side effects.

Worth asking to migrate, I believe NICE is recommending via a letter sent out to GPs about 3 months ago, that they prescribe pregablin.

Here is an interesting letter. I like to know what's going on lol

http://www.palliativedrugs.com/download ... ngland.pdf

Quote about how to prescribe, note the order of drugs to be given, cheapest first, and last the ones that are better for neuropathic pain but have actually been found to be the latest injected drug of choice, over heroin, on the black market in a couple of countries. lol

B
ackground
The National Institu
t
e for Clinic
al Excellence (NICE)
first
published
guidelines for non
-
diabe
tic neuropathic pain in
2010
1
. It recommended pregabalin or amitriptyline as first line treatments for non
-
diabetic neuropathic pain, and either
a combination of the two treatments, or a switch to the other drug as
second line therapy.
This was a controversial decision, even before the abuse potential of pregabalin became
evident
, since pregabalin is
considerably mo
re expensive than other options
, and there are no significant differences in efficacy
.
The exclusion
of
gabapentin was criticised by the Drug and Therapeutics Bulletin who questioned whether switching away from
gabapentin was a justifiable and affordable option
2
.
Local guidelines produced in 2011 placed pregabalin as a third
line option for
non
-
diabetic n
europathy
after tricyclic antidepressants and gabapentin. (Appendix 1)
Therefore NICE updated these guidelines in
November
2013
.
The new guidelines, CG 173
3
,
suggest offering a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatm
ent for ALLneuropathic pain (except trigeminal neuralgia)in adults in non specialist settings
.
If the initial drug is not effective or tolerated, then one of the other 3
drugs should be tried. If the second or third drugs remain ineffective or not tolerated then consideration should be
given to switching to the remaining options.
Local guidance is in the process of being updated in line with the revised
NICE guidance
.

So because the junkies are finding new highs, we the in pain, only get the the pregab if everything else does not work.

So endeth today's teachings, I need to move ;)
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby paulfoel » Tue Jun 23, 2015 9:43 am

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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby TheHud » Tue Jun 23, 2015 10:06 am

Yes Paul, pretty much is apart from side effects which are fewer possibly because a lower dose achieves the same results as a high gabapentin dose. I don't know the ins and out exactly but apparently it is better. Full chart would not transfer, but this is the write up

Difference between Gabapentin and Pregabalin chart (distinctive features are marked):

Gabapentin
(Neurontin®)

Pregabalin
(Lyrica®)
Drug class
Antiepileptic, GABA analogue
Mechanism of action Similar mechanism of action, but pregabalin has a stronger receptor binding affinity for the α2-δ protein subunit of voltage-gated calcium channels
Legal status Non-controlled Schedule V controlled substance
Proven potential for abuse and dependence
Common FDA approved indications
Post-herpetic neuralgia
Epilepsy in adults
Other FDA-approved indications Epilepsy in children age 3-12 years Fibromyalgia,
Painful diabetic peripheral neuropathy,
Neuropathic pain associated with spinal cord Injury
Bioavailability
Pregablin more predictable dose-effect relationship
Pain relieving potency pregabalin is 5 times more potent than gabapentin 11

Gabapentin and pregabalin are structurally and pharmacologically related compounds. Pregabalin is the pharmacologically active S-enantiomer of a gamma-amino acid analogue. Both anticonvulsants share many similar properties17 -- antiepileptic, analgesic, antineuropathic, and anxiolytic-like action; lack of drug interactions; minimal metabolism; renal elimination.

Pregabalin has several superior pharmacodynamic characteristics15. Pregabalin has a much higher bioavailability (90% versus 33-66%) and is rapidly absorbed (peak: 1 hour). Also, plasma concentrations increase linearly with increasing dose. Gabapentin is slowly absorbed (peak: 3 to 4 hours) and plasma concentrations have a non-linear relationship to increasing doses.

As an antiepileptic, pregabalin may be more effective than gabapentin in reducing the seizure frequency10.

In the treatment of neuropathic pain pregabalin has been shown in studies to provide equivalent efficacy to gabapentin, however, at much lower doses. The recent study of patients with neuropathic pain has shown that pregabalin can provide additional relief and improvement in quality of life in those who did not respond to gabapentin14.

Quote from USA FDA board

Pregabalin and gabapentin have structures similar to gamma-aminobutyric acid (GABA) and have similar mechanisms of action, modulating calcium influx in calcium channels. As a result, they both have analgesic, anxiolytic, and anticonvulsant activity. The primary differences between the two drugs are that:


* Pregabalin is more potent than gabapentin, so smaller doses are required;


* Because smaller doses are used, patients taking pregabalin experience fewer dose-related side effects, such as fatigue, dizziness, somnolence, dry mouth, peripheral edema, and blurred vision; and


* Pregabalin binds more tightly to pain receptors than does gabapentin
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby TheHud » Tue Jun 23, 2015 10:34 am

I think the main reason for looking at the two on here are the side effect reduction. Plus trials have shown that when gabapentin is not tolerated, side effects, pregab is and over 12 weeks any side effects pretty much go away. I have found they continue to reduce even after. Pregab is also excellent for when you get a massive breakthrough because it is absorbed in under an hour 90%. Looking at the research Gabapentin takes up to 4 hours to works and only 33 - 66% is ever absorbed, randomly so the dose can never be accurate.

I titrate up currently to 75mg 3 times a day. Again pregab lets me vary the times and the dose to some extent based on good days and bad days. For example

I took a pregab at 11 last night. I would normally take one at 7 this morning. I was not getting too much breakthough pain and wobbles etc. so I have only just taken it as the spasms and cramps started, 10.30.

I have also taken it at say 10pm and at 4am start hitting the had enough mark and can't sleep so take another. Aim currently to take between 150mg to max of 225mg.

I can also use it to plan ahead for when something is happening. I also admit to taking 2x75 within a couple of hours when it was my daughters birthday and I wanted to prevent me being ill and ruining her day.

Its flexible.

http://www.globalrph.com/pregabalin.htm
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Re: Cymbalta/Duloxetine - Any good for fibro?

Postby Zia2014 » Fri Jun 26, 2015 5:23 pm

Gaby was okay for me but still had side effects. Lyrica is a little more effective with no side effects bar one. Duloxetine made me wired!
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