Section 06
Neuropathic Pain
Nerve Pain & Peripheral Neuropathy
19 AGENTS
Gabapentin
NeurontinGabapentinoid
- Forms
- Cap: 100, 300, 400mg | Tab: 600, 800mg | Sol: 250mg/5mL
- Dose
- 900-3600mg/day
- MOA
- Binds α2δ Ca2+ channel subunit
Gabapentin enacarbil
HorizantGabapentinoid (prodrug)
- Forms
- ER tab: 300, 600mg
- Dose
- 600mg BID
- MOA
- Binds α2δ Ca2+ channel subunit
Pregabalin
LyricaGabapentinoid
- Forms
- Cap: 25, 50, 75, 100, 150, 200, 225, 300mg
- Dose
- 150-600mg/day
- MOA
- Binds α2δ Ca2+ channel subunit
Duloxetine
CymbaltaSNRI
- Forms
- DR cap: 20, 30, 40, 60mg
- Dose
- 60mg once daily
- MOA
- Serotonin/NE reuptake inhibition
Venlafaxine
Effexor XRSNRI
- Forms
- ER cap: 37.5, 75, 150, 225mg
- Dose
- 75-225mg/day
- MOA
- Serotonin/NE reuptake inhibition
Amitriptyline
ElavilTCA
- Forms
- Tab: 10, 25, 50, 75, 100, 150mg
- Dose
- 10-75mg qHS
- MOA
- Serotonin/NE reuptake inhibition
Nortriptyline
PamelorTCA
- Forms
- Cap: 10, 25, 50, 75mg | Sol: 10mg/5mL
- Dose
- 25-100mg qHS
- MOA
- Serotonin/NE reuptake inhibition
Desipramine
NorpraminTCA
- Forms
- Tab: 10, 25, 50, 75, 100, 150mg
- Dose
- 25-150mg/day
- MOA
- Predominantly NE reuptake inhibition
Carbamazepine
TegretolNa+ channel blocker
- Forms
- Tab: 200mg | XR: 100, 200, 400mg
- Dose
- 400-1200mg/day (trigeminal neuralgia)
- MOA
- Blocks voltage-gated Na+ channels
Oxcarbazepine
TrileptalNa+ channel blocker
- Forms
- Tab: 150, 300, 600mg
- Dose
- 600-1800mg/day (trigeminal neuralgia)
- MOA
- Blocks voltage-gated Na+ channels
Tramadol
UltramOpioid + SNRI
- Forms
- IR: 50mg | ER: 100-300mg
- Dose
- 50-100mg q4-6h PRN (max 400mg/day)
- MOA
- Weak mu-opioid agonist + NE/5-HT reuptake inhibition
Mexiletine
MexitilNa+ channel blocker (Class IB)
- Forms
- Cap: 150, 200, 250mg
- Dose
- 450-900mg/day divided
- MOA
- Blocks voltage-gated Na+ channels
Lidocaine 5% patch
LidodermNa+ channel blocker (topical)
- Forms
- Patch: 5% (700mg/patch)
- Dose
- apply 12h on / 12h off
- MOA
- Local Na+ channel blockade
Capsaicin 8%
QutenzaTRPV1 agonist (topical)
- Forms
- Patch: 8% (179mg)
- Dose
- in-office application, q3 months
- MOA
- Desensitizes TRPV1+ nociceptors
Capsaicin 0.025-0.1%
Zostrix (OTC, generic)TRPV1 agonist (topical)
- Forms
- Cream: 0.025%, 0.05%, 0.1%
- Dose
- apply TID-QID
- MOA
- Depletes substance P in nociceptors
Alpha-lipoic acid
generic/supplementAntioxidant supplement
- Forms
- Tab/Cap: 300, 600mg
- Dose
- 600mg once daily (diabetic neuropathy)
- MOA
- Reduces oxidative stress in nerve tissue
Tapentadol ER
Nucynta EROpioid + NE reuptake inhibitor
- Forms
- ER tab: 50, 100, 150, 200, 250mg
- Dose
- DPN: start 50mg BID, titrate to 100-250mg BID (max 500mg/day)
- MOA
- Mu-opioid agonism + norepinephrine reuptake inhibition
Gabapentin (once daily)
GraliseGabapentinoid
- Forms
- Tab: 300, 600mg
- Dose
- PHN: titrate to 1800mg once daily with evening meal
- MOA
- Binds α2δ Ca2+ channel subunit
Pregabalin CR
Lyrica CRGabapentinoid · ER
- Forms
- ER tab: 82.5, 165, 330mg
- Dose
- DPN: 165-330mg | PHN: 165-660mg once daily after evening meal
- MOA
- Binds α2δ Ca2+ channel subunit