Neuropathic pain medications

Medication	Dose range	Labs / monitor	Side effects
Gabapentin	300 mg/day titrated up slowly by 300 mg/day every 3-5 days (go from 300 mg/day q 1 day, then 300 mg BID for 1 day then 300 mg TID) you can start it as low as 100 mg/day to avoid sedation -administer it TID for effective blood level Maximum dose: 3600 mg	Monitor blood pressure in HTN patients (b/c of fluid retention) Lower dose in pts with renal insufficiency, B/c the kidneys excrete it.	Sedation, dizziness, ataxia, fluid retention
Pregabalin (Lyrica)	25 mg TID; increase to 100-200 mg TID, increase dose every three days by one tab.		Helps with sleep
Nortriptyline	Start 10 mg at bedtime; increase to 50-70 mg	EKG in patients over 40 Contraindicated in patients with narrow angle glaucoma, urinary retention, benign prostatic hypertension, impaired liver function, cardiovascular disease (ischemic cardiac disease, MI)	Xerostomia, blurred vision, constipation, urinary retention, postural hypotension, compensatory reflex tachycardia, memory dysfxn, cardiac depression, cardiac electrical conduction problems, arrhythmias
Amitriptyline	25-150 mg/day	Do not take if have you have problems with liver, kidney, heart, seizures, pregnant glaucoma or diabetes. Do not take with opioids or St John’s wort.	Irregular heart beat, yellow skin, eye pain or swelling, confused (low sodium), dry mouth dizziness difficulty peeing
Duloxetine Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs)	60 mg	Indicated for peripheral neuropathy and fibromyalgia.	DDI with MAO inhibitors. Some young people may have increased suicidal thoughts when first starting a medicine to treat depression.
Venlafaxine Serotonin-Norepinephrine Reuptake Inhibitor (SNRIs)	Start with 37.5-75mg/day; mean dose 225mg/day; Max 375mg/day XR take one tab/day	Hyponatremia (in older adult patients)	May increase risk of Serotonin Syndrome when used with TCAs, SSRIs, TCAs, tramadol, bupropion and buspirone. Caution with HTN, or seizures Nausea, headache, nervousness, tremor, dry mouth constipation and sexual dysfunction
Carbamazepine	Start at 100 mg BID and increase by 100 mg/day until decrease in pain or noted signs of toxicity. Divided doses Maximum dose: 1200 mg Maintenance dose : 600-1200 mg/day	Before starting: CBC and liver function tests (CMP will include this) Perform blood once a month for 3 months and then once every 3-6 months after Screen for patients genetically at risk HLA-B1502 (Asian patients) Aplastic anemia, leukopenia, neutropenia, thrombocytopenia, liver toxicity Steven Johnsons! Also remember to ask for MRI w/and w/o contrast to include cerebellopontine and brainstem when TN is suspected	Rash, sedation, vertigo, blurred vision, ataxia, gastric distress, confusion, decreased mental acuity Slow release has fewer side effects DO NOT USE IN PATIENTS WHO ARE ADVERSELY SENSITIVE TO TCA’S AS IT HAS SIMILAR STRUCTURE Take with food
Oxcarbazepine	Start with 150 mg at bedtime or BID; increase by 150 mg/day every 3-4 days to daily dose of 300-600 mg/day BID Therapeutic range: 1500-1800 mg/day in divided doses MAX dose: 2400 mg/day	Basic Metabolic Panel (Blood sodium) Normal range of serum Na: 135-145 mEq/L Hyponatremia (below 131) Signs of hyponatremia: nausea, vomiting, lethargy, fatigue, appetite loss, restlessness, irritability, headache, confusion, muscle weakness	Somnolence, dizziness *American Academy of Neurology recommends this as first line DON'T USE IN PATIENTS SENSITIVE TO CARBAMAZEPINE
Clonazepam/Klonopin	BMS:(start 0.25mg TID/ increase slowly to max of 3mg/day) – crush pill and dissolve in 2 tbs of water swish for 3 minutes spit. Follow up 1,3,6 months
Local anesthetic (lidocaine and benzocaine)