Table 5.

Preventive treatments in trigeminal neuralgia (adapted from Bendtsen et al ⁴¹)

Drug	Initiating dose	Titration*	Dose range	Frequency	Tapering†	Specific side effects
Carbamazepine	200 mg	200 mg every 3 days	200–1200 mg	Two to four times per day	200 mg every 7 days	Dizziness, drowsiness, fatigue, ataxia, diplopia, nausea, cognitive slowing, hyponatraemia leucopenia, thrombocytopenia, skin reactions, abnormal liver function tests
Oxcarbazepine	300 mg	300 mg every 3 days	300–1800 mg	Four times per day	300 mg every 7 days	Dizziness, drowsiness, fatigue, nausea, ataxia, hyponatraemia, skin reaction
Lamotrigine	25 mg	25 mg for 2 weeks, 50 mg for 1 week, then increase by 50 mg every week	25–400 mg	Two times per day	50 mg every 7 days	Dizziness, drowsiness, fatigue, headache, gastrointestinal symptoms, irritability, sleep disorders, tremor, cognitive slowing, rash
Gabapentin	300 mg	300 mg every 3 days	300–3600 mg	Three times per day	300 mg every 7 days	Dizziness, confusion, fatigue, ataxia, increased risk of infection, gastrointestinal symptoms, weight gain; use cautiously with opioids
Pregabalin	150 mg	150 mg every 7 days	150–600 mg	Two times per day	100 mg every 7 days	Dizziness, confusion, ataxia, increased risk of infection, gastrointestinal symptoms, weight gain
Baclofen	15 mg	15 mg every 7 days	15–90 mg	Three times per day	15 mg every 7 days	Confusion, dizziness, drowsiness, gastrointestinal symptoms, euphoria, hallucinations
Botulinum toxin type A	25–195 units	NA	25–195 units	Every 12 weeks	NA	Transient facial asymmetry, transient bruising at injection site, transient drooling and difficulty chewing

*The doses can be increased at a slower rate to improve tolerability; the doses are increased until the pain is well controlled, significant side effects intervene or the maximum dose is achieved.

†The doses can be reduced more gradually and in smaller decrements; the dose is reduced to either the minimum required to control the pain or allow cessation of drug without recurrence of pain.

NA, not applicable.