Table 2.
FDA approved neuropathic pain medications
| Medication | Indication | Beginning Dosages | Titration | Maximum Dosage | Duration of Adequate Trial |
|---|---|---|---|---|---|
| Gabapentin | Postherpetic neuralgia | 100–300 mg every night or 100–300 mg 3×/d | Increase by 100–300 mg 3×/d every 1–7 d as tolerated | 3600 mg/d (1200 mg 3 ×/d); reduce if low creatinine clearance | 3–8 wk. for titration plus 1–2 wk. at maximum tolerated dosage |
| Pregabalin | Diabetic neuropathic pain | 50 mg three times a day | Increase up to 100 mg three times a day | 600 mg a day | Start with 50 mg TID and increase up to 100 mg TID over 1 week |
| Lamotrigine | Postherpetic neuralgia | 200–400 mg every night. | Start with 25 to 50 mg every other day and increase by 25 mg every week. | 500 mg a day | 3 to 5 wk. for titration and 1–2 wk. at maximum tolerated dosage. |
| Carbamazepine | Trigeminal neuralgia | 200 mg/d (100 mg bid) | Add up to 200 mg/d in increments of 100 mg every 12 h | 1200 mg/d | |
| Duloxetine | Diabetic neuropathic pain | 30 mg | 30 mg weekly | 120 mg | 2 wk. |
| 5% lidocaine patch | Postherpetic neuralgia | Maximum of 3 patches daily for a maximum of 12 h. | None needed | Maximum of 3 patches daily for a maximum of 12 h. | 2 wk. |
| Opioid analgesics (in morphine equivalent dose) | Moderate to severe pain | 5–15 mg every 4 h. as needed | After 1–2 wk., convert total daily dosage to long-acting medication as needed | No maximum with careful titration; consider evaluation by pain specialist at dosages exceeding 120–180 mg/d | 4–6 wk. |
| Tramadol hydrochloride | Moderate to moderately severe pain | 50 mg 1 or 2×/d | Increased by 50–100 mg/d in divided doses every 3–7 d as tolerated | 400 mg/d (100 mg 4×/d); in patients older than 75 yr., 300 mg/d in divided doses | 4 wk. |
| Tricyclic antidepressants (e.g., nortriptyline hydrochloride or desipramine hydrochloride) | Chronic pain | 10–25 mg every night | Increase by 10–25 mg/d every 3–7 d as tolerated | 75–150 mg/d; if blood level of active drug and its metabolite is < 100 ng/mL, continue titration with caution | 6–8 wk. with at least 1–2 wk. at maximum tolerated dosage |
|
Duloxetine Serotonin/norepinephrine Reuptake inhibitor |
Diabetic neuropathic pain | 30 mg bid | Increase by 60 to 60 bid. No further titration | 120 mg/d | 4 wk. |
|
Fluoxetine Serotonin/norepinephrine Reuptake inhibitor |
Diabetic neuropathic pain | 30 mg bid | Increase by 60 to 60 bid. No further titration | 120 mg/d | 4 wk. |
| Tapentadol ER | Diabetic neuropathic pain | 50 mg bid | Increase by 50 mg/bid every 3 days as tolerated | 500 mg/d | ~ |