Tonmya

What it is

Tonmya is the first new medicine approved for fibromyalgia in more than 15 years (FDA-approved in 2025). It is a form of cyclobenzaprine — a medicine long used as a muscle relaxant — made to dissolve under the tongue. Taken at bedtime, it is designed to improve both widespread pain and the poor, unrefreshing sleep that is a hallmark of fibromyalgia. The idea behind it is that restoring deeper, more restorative sleep turns down the amplified pain signalling that defines fibromyalgia. Because it is absorbed through the lining of the mouth, it works differently from swallowed cyclobenzaprine tablets.

Before starting

Before starting, we review your other medicines — especially anything sedating or anything that raises serotonin (certain antidepressants and migraine or pain medicines), because effects can add up; a full medicine list keeps the combination safe. Tell us about heart rhythm problems, heart failure, or recent heart attack, and about liver problems or an overactive thyroid — cyclobenzaprine has long been used cautiously in those settings, and your provider will confirm Tonmya is appropriate for you. It is not combined with MAOI medicines. Also tell us if you are pregnant or planning pregnancy.

How it’s given

It is a small tablet placed under the tongue once a night at bedtime, where it dissolves — it is not swallowed like a regular pill. For the first two weeks, one tablet is taken nightly; after that, the usual dose is two tablets at bedtime. Let the tablet dissolve completely, and avoid eating or drinking until it has dissolved. Taking it right at bedtime matters: its sleep benefit is timed to the night, and it can cause sleepiness, which is welcome at night but not during the day.

What to expect

In studies, pain scores began improving within the first few weeks, with the effect building over about 3 months; sleep quality often improves alongside pain. The most common side effects are in the mouth where the tablet sits — numbness, tingling, or reduced sensation in the mouth and tongue, and an unusual taste — which are usually temporary. Dry mouth, sleepiness, headache, and fatigue can also occur. Take care with driving the next morning until you know how you feel. Call us for a racing or irregular heartbeat, marked confusion, or any reaction that worries you.

Everyday guidance

Make Tonmya part of your bedtime routine — same time each night, after you have finished eating and drinking for the evening. If you forget a dose, skip it and take the next night’s dose as usual; do not take it in the morning instead. Avoid alcohol in the evening, as it adds to sleepiness and fragments sleep. Keep a brief sleep-and-pain note for the first month; it helps us judge the response at follow-up. Tonmya works best alongside sleep habits, graded exercise, and pacing. Questions: call (361) 400-7700.