{ "schema_version": 1, "kind": "condition", "id": "fibromyalgia", "name": "Fibromyalgia syndrome", "category": "chronic", "sources": "Amitriptyline SmPC (https://www.medicines.org.uk/emc/product/4491/smpc) · Duloxetine US prescribing information, Dosage and Administration (DailyMed SetID fb37745f-fb40-4f7f-8143-ea1874c38e1b) · LYRICA (pregabalin) US prescribing information, Indications and Dosage and Administration (DailyMed SetID d4734e7d-5079-455e-8ff5-8f4539c998a9) · MSF Essential Drugs 2024 (tramadol oral monograph, moderate pain) · Fibromyalgia - disease-level clinical article (fibromyalgia-full.txt)", "review_status": "reviewed", "verified_against": "Amitriptyline SmPC (https://www.medicines.org.uk/emc/product/4491/smpc) · Duloxetine US prescribing information, Dosage and Administration (DailyMed SetID fb37745f-fb40-4f7f-8143-ea1874c38e1b) · LYRICA (pregabalin) US prescribing information, Indications and Dosage and Administration (DailyMed SetID d4734e7d-5079-455e-8ff5-8f4539c998a9) · Fibromyalgia - disease-level clinical article (fibromyalgia-clinical.txt) · MSF Essential Drugs 2024 (tramadol oral monograph, moderate pain) · Fibromyalgia - disease-level clinical article (fibromyalgia-full.txt)", "verified_date": "2026-08", "treatments": [ { "id": 760, "generic": "Amitriptyline", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 25.0, "adult_dose": "10-25 mg at bedtime, titrate by 10-25 mg every 1-2 weeks to 25-50 mg nightly (max 75 mg nightly)", "adult_duration": "long-term", "dose_source": "Amitriptyline SmPC (https://www.medicines.org.uk/emc/product/4491/smpc)", "rationale": "Strongest EULAR recommendation for sleep disturbance and centralized pain modulation in fibromyalgia", "cautions": [ "Anticholinergic side effects include dry mouth, blurred vision, constipation, and urinary retention.", "Contraindicated in severe cardiovascular disease, heart block, or recent MI.", "Sedation is common, so take the dose 1-2 hours before bedtime.", "Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist pediatric rheumatology referral required", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TRYPTIZOL 25 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 33.0, "pack_count": 30, "unit_price": 1.1, "strength_mg": 25.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANITYLLIN 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRAND PHARMA > DELTA GRAND PHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ZINOTRAVAL 25MG/5ML SYP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DEBEIKY > PHARMACHEMIC", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 25.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "fibromyalgia" }, { "id": 761, "generic": "Pregabalin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 75.0, "adult_dose": "300 to 450 mg/day. Start at 75 mg twice daily (150 mg/day); it may be increased to 150 mg twice daily (300 mg/day) within one week on efficacy and tolerability, and if 300 mg/day is not enough, to 225 mg twice daily (450 mg/day). Do not exceed 450 mg/day.", "adult_duration": "long-term", "dose_source": "LYRICA (pregabalin) US prescribing information, Indications and Dosage and Administration (DailyMed SetID d4734e7d-5079-455e-8ff5-8f4539c998a9)", "rationale": "Modulates voltage-gated calcium channels in the central nervous system, reducing excitatory neurotransmitter release and dampening the abnormal central pain processing that characterises fibromyalgia.", "cautions": [ "450 mg/day is the ceiling for fibromyalgia, not the 600 mg/day used in neuropathic pain and epilepsy. 600 mg/day was studied in fibromyalgia: the label says it gave no additional benefit and was less well tolerated, and that doses above 450 mg/day are not recommended.", "Weight gain, peripheral edema, and dizziness are common.", "Taper gradually when stopping.", "Fibromyalgia is not a licensed indication for pregabalin in the UK or Europe - the European label covers peripheral and central neuropathic pain, partial seizures and generalised anxiety, so prescribing here is off-label by those labels and should be discussed as such. It IS an approved US indication, and the figures here are that label's.", "Dose reduction is required in renal impairment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety not established in pediatric fibromyalgia", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FORPREGAB 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRAND PHARMA > PARKVILLE", "price_egp": 45.0, "pack_count": 30, "unit_price": 1.5, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SNAPGAB 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > TA PHARMA", "price_egp": 49.5, "pack_count": 30, "unit_price": 1.65, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LYRIBALIN 75MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 18.0, "pack_count": 10, "unit_price": 1.8, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NEURAGABALIN 75 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "DELTA GRAND PHARMA", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NERVATYCA 75 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 48.75, "pack_count": 20, "unit_price": 2.44, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "QUEENLEPT 75 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > ASPIN PHARMACEUTICAL", "price_egp": 93.0, "pack_count": 30, "unit_price": 3.1, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LYRICA 75MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 232.0, "pack_count": 20, "unit_price": 11.6, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PREGABEDIUM 75 MG 20 H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SABAA > ACTIVA THERAPEUTICS", "price_egp": 56.66, "pack_count": null, "unit_price": null, "strength_mg": 75.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNISWAB > VODACHEM", "price_egp": 43.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AVEROPREG 100MG/5ML SYRUP 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AVERROES PHARMA-EGYPT", "price_egp": 55.5, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "fibromyalgia" }, { "id": 763, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Fibromyalgia - disease-level clinical article (fibromyalgia-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Suicide risk is elevated in fibromyalgia patients, which is relevant to screening given the high rate of comorbid depression and anxiety." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "fibromyalgia" }, { "id": 762, "generic": "Duloxetine", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 60.0, "adult_dose": "30 mg once daily for 1 week, then increase to 60 mg once daily", "adult_duration": "long-term", "dose_source": "Duloxetine US prescribing information, Dosage and Administration (DailyMed SetID fb37745f-fb40-4f7f-8143-ea1874c38e1b)", "rationale": "Serotonin-norepinephrine reuptake inhibitor used as a second-line option for fibromyalgia; it enhances descending pain-inhibitory pathways in the central nervous system to reduce pain that has not responded to first-line therapy.", "cautions": [ "Avoid in severe renal impairment (eGFR < 30 mL/min) or chronic liver disease.", "Monitor blood pressure.", "Nausea, dry mouth, somnolence, and constipation are common." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not indicated in children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DULOPRESSIVE 60 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > TA PHARMA", "price_egp": 174.0, "pack_count": 30, "unit_price": 5.8, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEPRETREVE 60MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "INTERNATIONAL DRUG INDUSTRIES > ANDALOUS PHARMA", "price_egp": 148.0, "pack_count": 20, "unit_price": 7.4, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DULOXEPRIN 60 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 214.0, "pack_count": 28, "unit_price": 7.64, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CYMBATEX 60 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 295.5, "pack_count": 30, "unit_price": 9.85, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUCANDES 60 MG 28 CAPSULES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > INCANDESCE", "price_egp": 280.0, "pack_count": 28, "unit_price": 10.0, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CYMBALTA 60 MG 28 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ELI LILLY", "price_egp": 544.0, "pack_count": 28, "unit_price": 19.43, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUXNORZET 60 MG 30 DEL. REL. H.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 231.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WADILOXTIN 60 MG 28 DEL. REL. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "WADI ELNEEL BENTA", "price_egp": 280.0, "pack_count": null, "unit_price": null, "strength_mg": 60.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "fibromyalgia" }, { "id": 764, "generic": "Tramadol", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "50 to 100 mg every 4 to 6 hours (maximum 400 mg daily)", "adult_duration": "As short as possible", "dose_source": "MSF Essential Drugs 2024 (tramadol oral monograph, moderate pain)", "rationale": "The disease article names tramadol as a carved-out exception to its general opioid-avoidance advice, for patients with refractory symptoms. MSF Essential Drugs doses it for moderate pain and is explicit that it is for short-term treatment only, which sits in real tension with a chronic pain condition - so the restriction is carried onto the row verbatim rather than dropped. Placed at line 3, behind all three incumbent agents; nothing was re-ranked.", "cautions": [ "Use for short term treatment (risk of dependence and tolerance).", "According to clinical evolution; as short as possible.", "Do not administer in the event of severe respiratory depression and to patients that risk seizures.", "Do not combine with opioid analgesics, including codeine.", "Reduce doses by half and administer every 12 hours in elderly patients and in patients with severe renal or hepatic impairment (risk of accumulation)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "MSF states the dose for child over 12 years and adult together and gives no figure below 12 years.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TRAMAL 50MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > GRUNENTHAL-GERMANY", "price_egp": 18.0, "pack_count": 20, "unit_price": 0.9, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRAMADOL 50 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 22.0, "pack_count": 20, "unit_price": 1.1, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMADOL 50 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 29.0, "pack_count": 20, "unit_price": 1.45, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CONTRAMAL 100MG/ML ORAL DROPS 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 9.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "TRAMAL 100MG/ML ORAL DROPS. 10 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > GRUNENTHAL-GERMANY", "price_egp": 18.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "fibromyalgia" } ] }