Neuropathic Pain Treatments

Neuropathic Pain Treatments

NEUROPATHIC PAIN TREATMENTS
Generic	Brand	Strength	Form	Adult Dose
DIABETIC PERIPHERAL NEUROPATHY
L-Methylfolate
L-methyl– folate calcium/ algae-S powder/ pyridoxal 5-phos– phate/ methylco– balamin	Metanx	3mg/ 90.314mg/ 35mg/2mg	caps	1 cap twice daily or 2 caps once daily
Opioid
tapentadol	Nucynta  ER	50mg, 100mg, 150mg, 200mg, 250mg	ext-rel tabs	100–250mg twice daily (approx. every 12hrs). Opioid-naïve or opioid non-tolerant: Initially 50mg twice daily; titrate to optimal dose. Max 500mg/day. Moderate hepatic impairment: Initially 50mg once every 24hrs; max 100mg/day. Opioid conversions: See full labeling.
Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
duloxetine HCl	Cymbalta	20mg,  30mg, 60mg	del-rel caps	60mg once daily; may start at lower doses. Renal impairment: Consider lower starting dose and slow titration.
	Drizalma Sprinkle	20mg, 30mg, 40mg, 60mg	del-rel caps
Topical Analgesic
capsaicin	Zostrix Original Strength	0.033%	emol– lient crm	Apply 3−4 times daily
	Zostrix Maximum Strength	0.1%
Alpha2-Delta Ligand
pregabalin	Lyrica	25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg	caps	Initially 50mg 3 times daily, may increase to 100mg 3 times daily within 1wk. Renal impairment (CrCl <60mL/min): Reduce dose (see full labeling); hemodialysis: Give supplemental dose after session.
		20mg/mL	oral soln
	Lyrica CR	82.5mg, 165mg, 330mg	ext-rel tabs	Initially 165mg daily, may increase to max 330mg/day within 1wk. Renal impairment (CrCl 30–60mL/min): Reduce dose (see full labeling); (CrCl <30mL/min or hemodialysis): Dose with Lyrica.
FIBROMYALGIA
Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)
duloxetine HCl	Cymbalta	20mg, 30mg, 60mg	del-rel caps	Initially 30mg once daily for 1wk, then increase to 60mg once daily.
	Drizalma Sprinkle	20mg, 30mg, 40mg, 60mg	del-rel caps
milnacipran HCl	Savella	12.5mg, 25mg, 50mg, 100mg	tabs	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.
Alpha2-Delta Ligand
pregabalin	Lyrica	25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg	caps	Initially 75mg twice daily, may increase to 150mg twice daily within 1 wk as tolerated; max 450mg/day. Renal impairment (CrCl <60mL/min): Reduce dose (see full labeling); hemodialysis: Give supplemental dose after session.
		20mg/mL	oral soln
POSTHERPETIC NEURALGIA
gabapentin	Gralise	300mg, 600mg	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.
	Neurontin	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 full labeling); hemodialysis: 125−350mg after session.
		600mg, 800mg	scored tabs
		250mg/ 5mL	soln
gabapentin enacarbil	Horizant	300mg, 600mg	ext-rel tabs	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). 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 full labeling.
Alpha2-Delta Ligand
pregabalin	Lyrica	25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg	caps	Initially 75mg twice daily or 50mg 3 times daily; max 300mg/day after 1wk then 600mg/day after 2wks as tolerated. Renal impairment (CrCl <60mL/min): Reduce dose (see full labeling); hemodialysis: Give supplemental dose after session.
		20mg/mL	oral soln
	Lyrica CR	82.5mg, 165mg, 330mg	ext-rel tabs	Initially 165mg daily, may increase to 330mg daily within 1wk; max 660mg/day if insufficient relief after 2–4wks. Renal impairment (CrCl 30–60mL/min): Reduce dose (see full labeling); (CrCl <30mL/min or hemodialysis): Dose with Lyrica.
Topical Analgesic/Anesthetic
capsaicin	Qutenza	8% (179mg)	patch	Pretreat with topical anesthetic to reduce discomfort, once anesthetized, remove anesthetic and wash the treatment area. Apply to dry, intact skin within 2hrs of opening patch. Apply patch (up to 4 may be used) for 60mins (PHN) or 30mins (DPN), repeat every 3mos or as warranted by the return of pain (not more frequently than every 3mos). Treat acute pain during and following the procedure with local cooling and/or analgesics.
	Zostrix Original Strength	0.033%	emol– lient crm	Apply 3−4 times daily
	Zostrix Maximum Strength	0.1%
lidocaine	Lidoderm	5%	patch	To adjust dose, cut patches before removing release liner. May apply up to 3 patches at once for up to 12hrs of a 24‑hr period. Hepatic impairment or debilitated: Use smaller treatment areas.
	Ztlido	1.8%	patch
SPINAL CORD INJURY
Alpha2-Delta Ligand
pregabalin	Lyrica	25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg	caps	Initially 75mg twice daily, may increase to 150mg twice daily in 1wk, then max 600mg/day after 2wks as tolerated. Renal impairment (CrCl <60mL/min): Reduce dose (see full labeling); hemodialysis: Give supplemental dose after session.
		20mg/mL	oral soln
NOTES
Key: DPN = diabetic peripheral neuropathy; PHN = post-herpetic neuralgia (Rev. 7/2022)