About

Guaifenesin protocol is a popular, experimental, alternative treatment for fibromyalgia proposed in the 1990s by R. Paul St. Amand, MD. The treatment involves three parts: titrating to the proper guaifenesin dosage, avoiding salicylates, and following a low carbohydrate diet if the patient is hypoglycemic.

Guaifenesin has not been approved by the FDA for the treatment of fibromyalgia.

Treatment details

Anyone considering the guaifenesen protocol should read “What Your Doctor May Not Tell You About Fibromyalgia,” by R. Paul St. Amand, M.D., and Claudia Craig Marek. This is not optional. You will fail at the protocol if you do not understand it properly, and the only way to understand it properly is to read the book-- all of it. You can find a copy of the book at your local library, your local bookseller, or through the Fibromyalgia Treatment Center website. The Fibromyalgia Treatment Center is a non-profit dedicated to fibromyalgia treatment and research. I am not affiliated with them, and do not profit from sales of the book. I maintain this website because I was once very, very sick on fibromyalgia, and I am now much better, (although not fully well yet.)

Your obligation to others who are sick

My goal is to share resources with other people sick with fibromyalgia so that we can all get better together. The motto of the Fibromyalgia Treatment Center is “Spread Hope.” I take this motto very seriously, and wear it on a wristband, (one of those tacky rubber ones that are all the rage these days.)

Dr. St. Amand wrote something in his book that stuck in my head:

“Each of us who has conquered the disease owes something to those still sick. As wonderful as it is to feel well, we remain sad for those who are still miserable. As long as we receive e-mails and letters detailing lifelong struggles with pain, fatigue and relationships, our victory is not complete and our job is not yet done. We hope this book will provide the initiating core for a chain letter. As you get well, you progressively incur a debt, and you should plan to repay it. You can best do that by helping others who are still searching for the path you’ve already walked.” - R. Paul St. Amand, M.D. (“What Your Doctor May Not Tell You About Fibromyalgia,” p. 360, Warner Wellness, 2006.)

How much guai do I take to make myself feel worse?

Guaifenesin dosage

The dosage is individually determined by slowly titrating the dosage up until a worsening of symptoms is noticed. As the book puts it, you should feel “significantly but tolerably worse.” I suppose the ‘tolerably’ part is a matter of opinion, but the idea is if you are feeling worse, odds are you are now ‘cycling’, and have found your appropriate dosage. Patients begin with 300 mg twice a day. If you are not cycling yet, (which most people won’t be at just 300 mg, you then increase the dosage to the amount the book tells you about in Chapter Six of the book, entitled: “The Protocol.” (See? I’m not even telling you what that dosage for week two is. There’s no cheating on this. You HAVE to read the book. I don’t care if you are poor as a church mouse. Your library has a copy. This book has been around for a long time, and there are tons of copies of it circulating. There are no excuses for not reading the book. Hey, we all have fibromyalgia, and we found the focus, stamina and wherewithal to read the entire book, and you can, too.

Where do I get me some guaifenesen?
Can’t I just chug some of that sweet cherry Robitussin I have in the medicine cabinet?

Nope. The guaifenesin must be pure guaifenesin, and not a preparation including other medications. Robitussin has sugar and alcohol in it. That’s bad stuff for folks with fibro. You need pure guaifenesen. It used to be very easy to get generic guaifenesen, but it’s become more difficult in recent years, unfortunately. There’s a commercial brand of guaifenesen, called Mucinex, and this will work just fine, but like with any name brand, you’re paying for all their TV ads. (In the case of Mucinex, it’s a never-ending series of ads about blue and green mucous bugs. Lovely! So glad we can fund that fine bit of television programming!) You can ask your doctor for a prescription for dye-free guaifenesen, and then your pharmacy can fill it as a prescription. Yes, I did say above that guaifenesen is an over-the-counter drug in the United States, but you may get it filled at a pharmacy if you need the “dye-free” version due to “allergies” to the blue dye in the commercial form. This is how I get my guai. I purchase a year’s worth at a time. In case you’re wondering how much this sets me back, last year it cost about $230, I believe. I’m almost out, so I’ll let you know how much it is when I have it filled again this year. My guai was filled at the Marina del Ray pharmacy. You can also purchase regular guai from them (with the dye, without a prescription) and they can ship it worldwide. Pharmacist Jim is a helpful guy, and very knowledgeable about guaifenesen.

Marina del Rey Pharmacy
Jim Zelenay, Pharmacist
4558 So. Admiralty Way
Marina del Rey, CA 90292
Fax (310) 577-7562
Phone: (310) 823-5311
Orders taken by e-mail: zelenaymdrrx@aol.com

Where else can I get guai?

The Fibromyalgia Treatment Center webpage offers a handy reference page of other sources of guai. It’s up to you where you want to get your guai. Be aware there are different types of guaifenesen, (long-acting (LA)) versus (fast-acting (FA)) and they will impact your body difficulty, and affect your pain cycles. So, if you’re not sure you’re buying the right guai, email the online GuaiGroup Support Group and they’ll provide oodles of guidance on brands, dosages and formulations. With a 2,500 member support group behind you, it’s not nearly as complicated as it first sounds.

What are salicylates (“sals”)? Why do I have to avoid salicylic acid like the plague?

Salicylic acid in even tiny amounts blocks guaifenesin from binding in the kidneys. It is present in many drugs such as aspirin, Salsalate, Disalcid, Anacin, and Excedrin. Plants produce salicylic acid, so herbal medications must be avoided, as well as plant oils, gels and extracts in cosmetics and any product that touches the skin. These ingredients include aloe, castor oil, camphor, and mint. Any plants can be eaten, however, because the small amount of salicylic acid present in food is broken down in the digestive system and tagged with glycine by the liver before reaching the kidneys.

Yes, but does it actually work? (‘Cause this all sounds like a lot of bother, and I want some guarantees this thing is worth it.)

You’ll have to decide that one for yourself. There was one study done of guaifenesen which was inconclusive as to its effectiveness. Well, no, more accurately, they said it made no difference. The study was done before it was known that guai could very easily be blocked by salicylates, and many of the study participants were women, (which makes sense since 80% of fibro sufferers are women.) Women use a lot more beauty products than men. Women’s beauty products contain tons of salicylates. Go ahead. Grab the stuff you use on your face and body, your makeup, etc., and check out the ingredients. Look for the word “sal” in the ingredients, or the word “camp” or “menth” or the words “oil”, “gel” or “extract.” All indicators of plant products. Any of one those products could block guaifenesen. All of them together would definitely block guaifenesen. (The effect of sals is cumulative.) Oh, and that toothpaste of yours? Unless you’re using Tom’s of Maine Fennel or Silly Strawberry Toothpaste, or one of the other mint-free toothpastes, well, then, your toothpaste is just chock full of mint, and mint is a very powerful blocker. So, the guaifenesen would have blocked from the moment you brushed your teeth in the morning.

So, did the study fail? Heck, yeah! Should another one be done now that we know about sals? Yes, and I believe there is already another study in the works.

In the meantime, word of the guai protocol has spread mainly be word-of-mouth from folks like myself who have gotten better because of this treatment.

And, it’s been great to see the guaifenesen protocol gaining acceptance in the medical community. It used to be that if you mentioned the guaifenesen protocol to your doctor, one of three things would happen:

1) your doctor would tell you all about that failed study and why you were wasting your time,

2) your doctor would never have heard of the guaifenesen protocol

3) your doctor heard of the protocol, but gave you misinformation about how to do it.

A friend of mine recently had a checkup with a doctor fresh out of medical school. She had heard of the guaifenesen protocol! Hooorah! She knew what it was, she approved of it, and she correctly understood how it was done. Hallelujah!

I think the greatest acceptance of the guaifenesen protocol will come from younger doctors, who are open to new ideas, and new ways of thinking.

I’ve heard stories of open resistance and hostility to the protocol by doctors more set in their ways, but hopefully, if we are patient with them, they will eventually become a little more open-minded. There’s nothing like seeing patient after patient getting better on their own, and hearing their success stories, to open a physician’s eyes.

I’ve heard a number of stories of people getting misinformation from their doctors about how the protocol is done. I was told by my local rheumatologist that the part of the protocol about avoiding salicylates was “optional.” Hmmm.... did she read the book? Fortunately, I did.

Just heard another story of someone who was diagnosed with fibromyalgia by their doctor, told to take guaifenesen because “it helps some people,” and not given any more information than that. The dosage she was told to take was much too high, and set her into a terrible pain cycle. Fortunately, she found our online support group, realized the terrible blunders her doctor had made in her dosing, and is now doing better with the correct dosing.

This is just another reason why you MUST read the book, and not rely blindly on advice given at the doctor’s office. Doctors are humans, too, and they do make mistakes.

Sources:

Original text by Diana Torres plus reference material from Wikipedia

What is the guaifenesen protocol?