Fibromyalgia Conference Part 2 – Andrew Pothercary, the Pharmacist

I was excited to hear a pharmacist was speaking at the conference. His one hour slot proved to be quite informative, here’s some of the main points he spoke about:

(A quick disclaimer: This is notes and information I took from the presentation. Please speak with your doctor before taking or changing your medication, or driving/operating machinery whilst taking medication.)

Opiate Medication

  • New regulations of opiate medication have been brought in with regards to driving (think Tramadol, Morphine etc). whilst there is a level the police measure, it is possible to be about the level and not be impaired or below the level and not fit to drive. If you do get stopped and tested, it’s down to the discretion of the police force.
  • If you do take opiate medication, it may be worth keeping a repeat prescription or letter from your doctor in your bag if you do drive.
  • Tramadol was moved in to Class C and regulated drug controls because of illegal misuse, not because of prescription medication.
  • If you are prescribed a controlled drug, the prescription is valid for only 28 days, and you should not be prescribed more than one months worth of tablets.
  • When collecting the medication you will now be asked to sign a blue box on the back of the prescription, you may also be asked for ID.
  • With Morphine, it is highly addictive and in time can lead to increased pain, and then more Morphine leaving you in a viscous circle of pain and reliance.
  • Tramadol gives improved functions, but is known for dependency and withdrawal symptoms.

Pregabalin and Gabapentin

  • The patent has now expired for the medication meaning it can now be made by other drug companies and will not come in a box marked Lyrica, it will only state Pregabalin.
  • Lyrica is usually prescribed as pain relief, although it is not licensed for fibromyaligia, pain is a symptom of the condition.
  • In studies, 28% of people stopped taking Gabapentin due to side effects.
  • Another study suggests 1 in 11 people get significant improvement of symptoms when taking Pregabilin.
  • Pregabilin is adsorbed quicker than Gabapentin and therefore is more effective.
  • Gabapentin gives higher levels of pain relief but 1 in 3 found side effects for pain treatment intolerable.
  • 300mg per day of Pregabalin is the minimum requirement to provide pain relief.
  • A drug called Microgabalin is in trials. It is similar to Pregabalin but has more specific targets (pain).

Amitriptyline

  • 4 out of 5 trials showed a positive pain outcome but;
  • Long term use was shown to work in 4 out of 5 people.
  • Leaves people with a ‘hangover feeling the next day’

Prozac (fluoxetine)

  • This drug showed positive outcomes in both pain and function.

General points

  • With antidepressants, side effects will diminish over time.
  • New antidepressants are being trialled for fibro symptoms but so far they have had serious side effects.
  • Visit clinical trials.gov and search for fibro. There are currently no open studies in the UK. This is a US site but worldwide studies are listed there.
  • There are a number of ongoing trials in South America, Europe, New Zealand and the US into many types of deficiencies and benefits of medications.

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