NEUROPATHIC PAIN TREATMENTS | ||||
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Generic | Brand | Strength | Form | Adult Dose |
DIABETIC PERIPHERAL NEUROPATHY | ||||
L-Methylfolate | ||||
L-methyl– folate calcium, pyridoxal 5-phos– phate, methylco– balamin |
Metanx | 3mg/ 35mg/ 2mg |
tabs | 1−2 tabs 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 |
e-c pellets in caps | 60mg once daily; may start at lower doses. Renal impairment: Consider lower starting dose and slow titration. |
Topical Analgesic | ||||
capsaicin | Zostrix | 0.025% | emol– lient crm |
Apply 3−4 times daily |
Zostrix‑HP | 0.075% | |||
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 | e-c pellets in caps | Initially 30mg once daily for 1wk, then increase to 60mg once daily. |
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 60min, 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 | 0.025% | emol– lient crm |
Apply 3−4 times daily | |
Zostrix‑HP | 0.075% | |||
lidocaine | Lidoderm | 5% | adhe– sive 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. |
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 | |||
(Rev. 7/2019) |
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