NEUROPATHIC PAIN
 
Generic & Class Brand & Company Strength Formulation Usual Adult Dose
DIABETIC PERIPHERAL NEUROPATHY
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)
duloxetine HCl CYMBALTA
Lilly
20mg, 30mg, 60mg e-c pellets in caps Swallow whole. 60mg once daily (may start at lower dose if 60mg not tolerated); renal impairment: consider lower starting dose and slow titration.
α2-DELTA LIGAND
pregabalin LYRICA
Pfizer
25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg caps ≥18yrs: initially 50mg 3 times daily, may increase to 100mg 3 times daily within 1 week. Renal impairment (CrCl <60mL/min): reduce dose (see literature); hemodialysis: give supplemental dose after session.
FIBROMYALGIA
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)
duloxetine HCl CYMBALTA
Lilly
20mg, 30mg, 60mg e-c pellets in caps Swallow whole. Initially 30mg once daily for 1 week, then increase to 60mg once daily.
milnacipran HCl SAVELLA
Forest & Cypress
12.5mg, 25mg, 50mg, 100mg tabs May take with food. Titrate dose. Day 1: 12.5mg once. Days 2–3: 12.5mg twice daily. Days 4–7: 25mg twice daily. After Day 7: 50mg twice daily (recommended dose); max 100mg twice daily. Severe renal impairment (CrCl 5–29mL/min): maintenance 25mg twice daily; max 50mg twice daily. Withdraw gradually.
α2-DELTA LIGAND
pregabalin LYRICA
Pfizer
25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg caps ≥18yrs: initially 75mg twice daily, may increase to 150mg twice daily within 1 week as tolerated; max 450mg/day. Renal impairment (CrCl <60mL/min): reduce dose (see literature); hemodialysis: give supplemental dose after session.
POSTHERPETIC NEURALGIA
gabapentin NEURONTIN CAPSULES
Pfizer
100mg, 300mg, 400mg caps 300mg once on day 1, twice daily on day 2, and 3 times daily on day 3; may titrate up to usual max 1.8g/day in 3 divided doses (doses up to 3.6g/day have been used without added benefit). Renal dysfunction: CrCl 30–59mL/min: 400–1400mg/day twice daily; CrCl 15–29mL/min: 200–700mg once daily; CrCl ≤15mL/min: 100–300mg once daily (see literature); hemodialysis: 125–350mg after session.
NEURONTIN TABLETS
Pfizer
600mg+, 800mg+ tabs
NEURONTIN ORAL SOLN
Pfizer
250mg/5mL soln
α2-DELTA LIGAND
pregabalin LYRICA
Pfizer
25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg caps ≥18yrs: initially 75mg twice daily or 50mg 3 times daily; max 300mg/day after 1 week then 600mg/day after 2 weeks as tolerated (see literature). Renal impairment (CrCl <60mL/min): reduce dose (see literature); hemodialysis: give supplemental dose after session.
TOPICAL ANESTHETIC
capsaicin QUTENZA
NeurogesX
8% (179mg) adhesive patch Identify treatment area and mark the skin; may cut patches to match size and shape of area. Apply to dry, intact skin within 2 hours of opening patch. Apply patch (up to 4 may be used) for 60 minutes, repeat every 3 months or as warranted by the return of pain (not more frequently than every 3 months). May use a dressing to ensure patch remains in contact with treatment area. After removal of patch, apply Cleansing Gel to area and leave on for at least one minute. Remove Cleansing Gel with dry wipe; wash and dry the area. Treat acute pain during and following the procedure with local cooling and/or analgesics. Use nitrile gloves when handling patch and cleaning capsaicin residue from skin. Immediately dispose of patches.
lidocaine LIDODERM
Endo
5% adhesive patch Apply to intact skin, covering most painful area. To adjust dose, cut patches before removing release liner. Remove if irritation or burning occurs; do not reapply until irritation subsides. May apply up to 3 patches at once for up to 12 hours of a 24-hour period. Hepatic impairment or debilitated: use smaller treatment areas.
NOTES

+ = scored

(Rev. 7/2010)