Do you view the difference between oral and sublingual cyclobenzaprine as clinically significant? 

Yes. Oral cyclobenzaprine—a TCA analogue structurally identical to amitriptyline aside from a single double bond—has been used off-label for fibromyalgia for many years. Despite long-standing anecdotal benefit, a prospective placebo-controlled RCT showed only transient improvement at 4 weeks, with n...

Cyclobenzaprine has a 30–40 year track record in the treatment of fibromyalgia. For many patients, the primary limitation is not efficacy but tolerability.

There are no head-to-head trials comparing oral and sublingual cyclobenzaprine. The clinically meaningful difference between the two formulation...

The potential advantage of sublingual vs oral cyclobenzaprine is likely related to less adverse side effects, especially early morning sedation. Therefore, I would consider trying the sublingual form in FM patients who failed the oral form, especially because of adverse side effects. I likely would ...