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Table 2 FDA approved neuropathic pain medications

From: Addressing chronic persistent headaches after MTBI as a neuropathic pain state

Medication

Indication

Beginning Dosages

Titration

Maximum Dosage

Duration of Adequate Trial

Gabapentin

Postherpetic neuralgia

100–300 mg every night or 100–300 mg 3×/d

Increase by 100–300 mg 3×/d every 1–7 d as tolerated

3600 mg/d (1200 mg 3 ×/d); reduce if low creatinine clearance

3–8 wk. for titration plus 1–2 wk. at maximum tolerated dosage

Pregabalin

Diabetic neuropathic pain

50 mg three times a day

Increase up to 100 mg three times a day

600 mg a day

Start with 50 mg TID and increase up to 100 mg TID over 1 week

Lamotrigine

Postherpetic neuralgia

200–400 mg every night.

Start with 25 to 50 mg every other day and increase by 25 mg every week.

500 mg a day

3 to 5 wk. for titration and 1–2 wk. at maximum tolerated dosage.

Carbamazepine

Trigeminal neuralgia

200 mg/d (100 mg bid)

Add up to 200 mg/d in increments of 100 mg every 12 h

1200 mg/d

 

Duloxetine

Diabetic neuropathic pain

30 mg

30 mg weekly

120 mg

2 wk.

5% lidocaine patch

Postherpetic neuralgia

Maximum of 3 patches daily for a maximum of 12 h.

None needed

Maximum of 3 patches daily for a maximum of 12 h.

2 wk.

 Opioid analgesics (in morphine equivalent dose)

Moderate to severe pain

5–15 mg every 4 h. as needed

After 1–2 wk., convert total daily dosage to long-acting medication as needed

No maximum with careful titration; consider evaluation by pain specialist at dosages exceeding 120–180 mg/d

4–6 wk.

Tramadol hydrochloride

Moderate to moderately severe pain

50 mg 1 or 2×/d

Increased by 50–100 mg/d in divided doses every 3–7 d as tolerated

400 mg/d (100 mg 4×/d); in patients older than 75 yr., 300 mg/d in divided doses

4 wk.

Tricyclic antidepressants (e.g., nortriptyline hydrochloride or desipramine hydrochloride)

Chronic pain

10–25 mg every night

Increase by 10–25 mg/d every 3–7 d as tolerated

75–150 mg/d; if blood level of active drug and its metabolite is < 100 ng/mL, continue titration with caution

6–8 wk. with at least 1–2 wk. at maximum tolerated dosage

Duloxetine

Serotonin/norepinephrine

Reuptake inhibitor

Diabetic neuropathic pain

30 mg bid

Increase by 60 to 60 bid. No further titration

120 mg/d

4 wk.

Fluoxetine

Serotonin/norepinephrine

Reuptake inhibitor

Diabetic neuropathic pain

30 mg bid

Increase by 60 to 60 bid. No further titration

120 mg/d

4 wk.

Tapentadol ER

Diabetic neuropathic pain

50 mg bid

Increase by 50 mg/bid every 3 days as tolerated

500 mg/d

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