New Zealand Fibromyalgia Information

Paul St. Amand, M.D., Assistant Clinical Professor of Endocrinology at Harbor-UCLA believes guaifenesin therapy can significantly help fibromyalgia (FM) patients combat their symptoms and lead normal, healthy lives.

Dr. St. Amand’s theory of the medicinal effects of guaifenesin for FM is based on the premise that excess calcium and inorganic phosphate compounds accumulate within cells to produce a state of hyperpermeability. This condition allows excess fluids, ions and other unwanted substances to flow into cell mitochondria, disrupting normal cell function, including production of ATP, the body’s energy source. Dr. St. Amand believes these factors cause the body to experience an energy deprived state, in which widespread bodily functions are disrupted. Dr. St. Amand also feels a possible genetic defect in FM patients may be responsible for the abnormality in natural phosphate excretion, thus resulting in the buildup of these chemicals and subsequent symptoms.

Guaifenesin is a common component of many cold and cough remedies that helps loosen and liquefy mucous. It is a safe medication that may even be used by children.

Derived from a tree bark extract called guaiacum, it was first used to treat rheumatism during the 16th century. Twenty years ago, the extract was synthesized, pressed into tablets and named guaifenesin. Today, there are many formulations of guaifenesin available, the most popular being extended release tablets that deliver both immediate and long lasting effects.

Guaifenesin is regarded by Dr. St. Amand as the most potent drug to date for treating FM. In Dr. St. Amand’s guaifenesin protocol, a physician maps the location, size and degree of hardness of swellings or lesions within muscles, tendons and ligaments all across the body. The map serves as a baseline for future comparisons during guaifenesin treatment. Patients also make note of variations in the amount of pain and fatigue they experience, and the combined input is used to determine the proper guaifenesin dosage and to confirm the regression of the disease.

The initial goal of guaifenesin treatment is to exacerbate the patient’s symptoms. Dr. St. Amand stresses that the worsening of FM symptoms, or the appearance of new symptoms indicates that disease reversal has begun. Dosage generally begins with 300mg (one-half tablet) of time released guaifenesin twice daily for one week. If symptoms have not worsened, the dosage is increased to 600mg twice daily. As treatment continues and the reversal process progresses, periods of less intense symptoms appear. As time passes, these periods cluster into days and weeks and lesions begin to clear. He has also reported a 60% increase in phosphate excretion and a 30% increase in oxalate in patients’ urine, indicating that the offending compounds are effectively being removed from the body.

An important part of Dr. St. Amand’s protocol focuses on the avoidance of salicylates. In nature, salicylates are manufactured by plants as a defence against bacteria and fungi. Aspirin and other herbal or plant based products contain salicylates or salicylic acid. Any product containing salicylates can completely block the benefits of guaifenesin. The human body easily absorbs salicylates through the skin and intestines, so patients taking guaifenesin must be wary of medicines, supplements, lotions, cosmetics and even garden plants which can neutralise guaifenesin treatment.

In 1995 the only double blind, placebo controlled study of guaifenesin in FM was conducted by Robert Bennett, M.D. and fellow researchers at the University of Oregon1. Time released guaifenesin treatment (600mg twice daily) was administered to 20 female FM patients. Results showed guaifenesin was no more effective at relieving symptoms of FM than placebo. However, according to Dr. St. Amand, there may have been some flaws in the study that resulted in the poor results. He cites these key points in refuting the study findings:

1. The study was conducted before anyone knew the signs of reversal are not apparent if the subject has uncontrolled reactive hypoglycemia. At the time, the frequency of reactive hypoglycemia was relatively unknown.

2. The complete range of salicylate containing products and their capacity to block the effects of guaifenesin was not well known during the study. Also, each patient seems to have a different sensitivity to products containing salicylates.

3. Inadequate dosage may have been a factor. St. Amand reports that only 20% of his patients improve with a 300mg dose of time released guaifenesin twice daily, while at 600mg (time released) twice daily, 70% of patients improve. Dr. St. Amand points out that guaifenesin treatment is trying. As the disease reverses, patients feel symptoms intensify and new or dormant symptoms can surface. This causes some patients to doubt their progress during the initial stages of treatment; however, Dr. St. Amand reports that as good days begin to accumulate, patients will have more confidence and strength to go on with treatment. Guaifenesin is not a cure for FM; the underlying condition that caused the build up of phosphates remains, and will return if the patient ends therapy. Therapy is a long term commitment but may offer significant rewards.

Please see our Guaifenesin section for further information in New Zealand and Australia. Click here

1. Bennett, R. M., De Garmo, P., Clark, S.R. “A 1 year double blind placebo-controlled study
of guaifenesin in fibromyalgia.” Arthritis and Rheumatism 1996 39: S212