instruction: hello doctor my mother is 53 years old nondiabetic she is hypertensive 150 100 and having all over body pain fatigue and morning stiffness we consulted a neurologist and she was diagnosed with fibromyalgia she was going about daily activities by using painkiller every day innova my diclofenac paracetamol chlorzoxazone before the diagnosis the prescription for fibromyalgia was formalin methylcobalamin pyearidoxine folic acid one tablet in the noon duloxetine gastro resistant duloren 20mg duloxetine my 25 tablet for first days 10 my for the next five days and 20 my there after our main concern is duloxetine she has started my per day dose for a week but is scared to take this medicine as we have come across online references where duloxetine cymbalta actually aggravated the problem like duloxetine changes a person behavior for worse like the person taking it does not remain the same anymore after taking it for few months becomes emotionally vulnerable and may have suicidal tendencies etc also duloxetine has severe withdrawal problem the dose has to be tapered very slowly changing to different medication becomes very difficult is it true duloxetine damages critical organs like liver also can cause serotonin syndrome she is not on any other sari psychotropic medicine for how long she has to take duloxetine will she be ever off on it once she feels better if the medicine is to be continued do we have any other safe pharmaceutical alternatives to duloxetine would you recommend any supplements for fibromyalgia since it is sari will it adversely affect her blood pressure she is taking atenolol 50 my per day currently and her be under control with it please advise regarding the safety and efficacy of this drug as there are countless negative reviews about it on youtube and social media
output: hello welcome to icliniq com regarding your concern I would explain that morning stiffness is not a typical sign of fibromyalgia but it could indicate a rheumatological disorder coming to this point considering her slightly elevated erythrosedimentation I would recommend performing other tests before concluding about fibromyalgia in this regard I would recommend performing rheumatoid factor plasma levels ana anti nuclear antibody and anna anti neutrophil cytoplasmic antibody titer a nerve conduction study is also necessary to exclude possible neuropathy although she does not have diabetes if these tests result normal she can continue taking duloxetine and gradually increase the dose up to 60 my daily which is the maintenance therapeutic dose you should not worry so much about this drug it can be stopped gradually like the way she is starting it if it is started slowly it does not lead to serotonin syndrome as long as she is not taking any other sari selective serotonin reuptake inhibitors after stopping this drug other drugs may be tried like pregabaline etc anyway the internet is not the best doctor to ask because the information is very wide and nonspecific every drug has adverse effects but they usually occur in a low percentage of patients especially when high doses are used without starting slowly I hope this helps