R. Paul St. Amand, M.D.
Endocrinologist |
Guaifenesin Treatment
R. PAUL ST. AMAND, M.D.
Over the past 37 years, I have successfully treated 3,500 fibromyalgia patients with several uricosuric (gout) drugs including, most recently, the simple medication, guaifenesin. Many of my patients have also had vulvodynia, which I consider part of the disease.
Among the many symptoms of fibromyalgia, the most prominent are pain and stiffness in the muscles, tendons, and ligaments. Other common symptoms include fatigue, irritability, depression, poor memory, and lack of concentration. Fibromyalgics typically also suffer with irritable bowel syndrome, urethral syndrome, painful intercourse, headaches (often one-sided), burning hands and feet, and more. In short, people with fibromyalgia have a lot of complaints.
Fibromyalgia appears to be an inherited biochemical abnormality that primarily affects women. Symptoms can develop at any age, including childhood, and progress in cycles. At first, they may be mild, with long gaps or remissions between attacks. Eventually, however, the symptoms worsen, with no more good days in between the bad days.
After patients begin taking guaifenesin, the symptoms reverse as they developed, in cycles, but several times faster — like rewinding a videotape of one's illness. Unfortunately, they often are worse than before, since the reversal involves many areas simultaneously. Gradually and progressively, however, more good days appear, cluster together, and the patient is finally restored to normal. My experience is that about two months at the proper dosage reverses at least one year of accumulated disease.
Guaifenesin, a drug used to liquefy mucus, is mildly uricosuric. Uricosuric drugs are used to treat gout by causing urinary excretion of uric acid. Many years ago, quite by accident, I discovered that uricosuric drugs also work for fibromyalgia. (I must stress, however, that fibromyalgia and gout have no connection.) Unlike the potent uricosuric drugs used in the past, guaifenesin has few, if any, side effects.
Having stumbled onto an effective treatment, it seemed appropriate to formulate a theory based on the results. Upon analyzing twenty-four hour urine collections in a few patients, before and after treatment, I found a significant increase in the excretion of phosphate and a moderate increase of oxalate and calcium after guaifenesin was started. I suspected that the body cells of fibromyalgics retain abnormal amounts of substances that should have been excreted by the kidneys. This abnormality, which may be due to an inherited enzymatic deficiency, leads to symptoms fibromyalgics experience in so many tissues and systems of the body.
My hypothesis, which is subject to further research, is that an excess of intracellular phosphate, and possibly oxalate, builds up in cells and depresses formation of energy (ATP) in the cells' "power stations," the mitochondria. Other researchers have discovered multiple biochemical abnormalities in connection with fibromyalgia.
The required dosage of guaifenesin is determined by patient response. It varies from 300 mg. twice a day to as high as 3600 mg. per day. Guaifenesin has been used for over twenty years; has no significant, listed side effects; and is safe for children.
Treatment progress is measured both by symptom improvement and by filling in body maps showing the location and size of tender points, spasms, or hard patches felt in the muscles and ligaments. As guaifenesin "clears" fibromyalgia out of the body, these patches decrease in size and eventually disappear.
Aspirin & Aloe: A key aspect of treatment is that salicylates, contained in aspirin and other compounds, completely block the effects of all uricosuric drugs, including guaifenesin. Moreover, skin readily absorbs salicylates into the body. Salicylates are manufactured by all plants, the choicest parts of which are concentrated to make herbal medications, many cosmetics, and deodorants.
Thus, patients being treated with guaifenesin cannot take aspirin or herbal medications, or use any skin creams or topical products which contain herbs, including aloe. Castor oil, Listerine, Ben Gay, and razors with aloe strips are among the many culprits that block the action of guaifenesin. When blocking occurs, patients have no adverse effects; they simply obtain no benefit for fibromyalgia.
Hypoglycemia: Another complicating factor in guaifenesin treatment is hypoglycemia, or "low blood sugar," better defined as carbohydrate intolerance. Some of the many symptoms of hypoglycemia are tiredness, panic, palpitations, and lightheadedness after eating sugar or starch. Hypoglycemia can be controlled by a strict diet that eliminates sugar, most carbohydrates, and caffeine.
As an endocrinologist, I see many hypoglycemics and have found that around 40% of my fibromyalgia patients are hypoglycemic. It is mandatory that the two syndromes be treated concurrently, or the patient will not feel better. The added energy drain of hypoglycemia, untreated, can also make guaifenesin treatment intolerable.
Maintenance Dosage: Since inherited abnormalities like fibromyalgia cannot be cured, only controlled, patients must take guaifenesin for the rest of their lives, or the symptoms will return. Therefore, a maintenance dosage is necessary, usually the same amount it took to clear them. Some of my earliest patients have been taking uricosuric drugs for over 30 years, and maintain a high quality of life.
