What is your approach to titration of sublingual cyclobenzaprine in your patients with fibromyalgia?

Follow the FDA instructions: start at 2.8 mg sublingually at bedtime for 14 days, if tolerating, then increase to 5.6 mg nightly starting day 15 onwards.

Ensure the mouth is not too dry as saliva is needed for it to fully dissolve, which could take 2-3 mins.

This may be a concern in patients with SI...

Re titration, I would recommend following the titration FDA approved schedule and not go higher than recommended.

As per the FDA package insert and studies used to get approval for fibromyalgia, the dosing is 2.8 mg SL at bedtime for 14 days, then increase to two pills or 5.6 mg at bedtime thereafter. Instruct the patient to make sure the mouth is moist with sips of water before administration and not to swallo...