Neuropathic Pain
| NEUROPATHIC PAIN | ||||
|---|---|---|---|---|
| Generic & Class | Brand & Company | Strength | Formulation | Usual Adult Dose |
| DIABETIC PERIPHERAL NEUROPATHY | ||||
| L-METHYLFOLATE | ||||
| L-methylfolate calcium, pyridoxal 5-phosphate, methylcobalamin | METANX
PamLab |
2.8mg/25mg/2mg | tabs | Swallow 1–2 tabs daily. |
| OPIOID | ||||
| tapentadol | NUCYNTA ER
Janssen |
50mg, 100mg, 150mg, 200mg, 250mg | ext-rel tabs | Swallow one tablet at a time. Initially 50mg twice daily. May increase 50mg no more than twice daily every three days; max dose 500mg/day. |
| 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. |
| TOPICAL ANALGESIC | ||||
| capsaicin | ZOSTRIX
Hi-Tech Pharmacal |
0.025% | emollient crm | Apply 3–4 times daily. |
| ZOSTRIX-HP
Hi-Tech Pharmacal |
0.075% | emollient crm | Apply 3–4 times daily. | |
| ZOSTRIX NEUROPATHY CREAM
Hi-Tech Pharmacal |
0.25% | crm | Apply 2–4 times daily. | |
| 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 | GRALISE
Depomed |
300mg, 600mg | tabs | Swallow whole; do not crush, split or chew tabs. Take once daily with the evening meal. ≥18yrs: initially 300mg on Day 1, 600mg on Day 2, 900mg on Days 3–6, 1200mg on Days 7–10, 1500mg on Days 11–14, titrate up to 1800mg on Day 15. Renal impairment: CrCl 30–60mL/min: 600–1800mg. CrCl <30mL/min or on hemodialysis: not recommended. |
| HORIZANT
GlaxoSmithKline |
300mg, 600mg | ext-rel tabs | Swallow whole. Take with food. Initially 600mg in the AM for 3 days, then increase to 600mg twice daily beginning on Day 4 (no additional benefit seen with >1200mg daily dose). If dose is not taken at recommended time, skip this dose, and the next dose should be taken at the time of the next scheduled dose. Renal impairment: CrCl 30–59mL/min: initially 300mg in the AM for 3 days, then 300mg twice daily; may increase to 600mg twice daily if needed or tolerated. CrCl 15–29mL/min: 300mg in the AM on Day 1 and Day 3, then continue with 300mg in AM; may increase to 300mg twice daily if needed. CrCl <15mL/min: Maintenance: 300mg every other day in the AM, may increase to 300mg once daily if needed. CrCl <15mL/min on hemodialysis: Maintenance: 300mg after every session, may increase to 600mg if needed. Tapering doses: see literature. | |
| 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 | ||
| NEURTONTIN 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 ANALGESIC/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. Pretreat with topical anesthetic to reduce discomfort, once anesthetized, remove anesthetic and wash the treatment 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. |
| ZOSTRIX
Hi-Tech Pharmacal |
0.025% | emollient crm | Apply 3–4 times daily. | |
| ZOSTRIX-HP
Hi-Tech Pharmacal |
0.075% | emollient crm | Apply 3–4 times daily. | |
| ZOSTRIX NEUROPATHY CREAM
Hi-Tech Pharmacal |
0.25% | crm | Apply 2–4 times daily. | |
| 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. |
| SPINAL CORD INJURY | ||||
| 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; max dose of 300mg twice daily (600mg/day). |
| NOTES | ||||
|
+ = scored (Rev. 12/2012) |
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