Table 1.

Medical Therapies for the Treatment of Trigeminal Neuralgia

Medication	Common Dosing	Side Effects	Monitoring
Carbamazepine	50 mg twice a day (elderly population) 100 mg twice a day (younger populations)	HLA-B*1502 variant patients, esp. in Asian patients, have increased risk of SJS/TEN Drug-drug interactions, by inducing CYP3A4	Monitor sodium, CBC, LFTs at baseline and periodically after HLA-B*1502 variant screening
Oxcarbazepine	150 mg twice a day (to start) 300–600 mg twice a day (goal; max 1800 mg per day)	Hyponatremia HLA-B*1502 variant patients have increased risk of SJS/TEN	Monitor sodium, HLA-B*1502 variant screening
Phenytoin and fosphenytoin	15–20mg/kg	Ataxia, dysarthria, nystagmus Significant incidence of recurrence of the neuralgia despite continuous use	If long-term dosing attempted, free and total phenytoin levels
Baclofen	15–80mg per day	Sedation, hypotonia, GI upset	NA
Lamotrigine	100bid	SJS/TEN, skin rash, sedation, nausea	NA
Pimozide	4–12 mg per day	Extrapyramidal symptoms, QT prolongation, neuroleptic malignant syndrome, hemolytic anemia, dry mouth, sedation, constipation	ECG, fasting glucose and lipids, CBC, CMP, monitoring for extrapyramidal symptoms
Levetiracetam	3000–5000 mg per day divided BID or TID	Agitation or worsening depression	NA
Gabapentin	300–1200 mg TID	Sedation, foggy thinking, lower extremity edema or weight gain	NA
Pregabalin	300–600 mg divided BID	Sedation, dizziness, lower extremity edema, blurry vision, possible thrombocytopenia	NA
Clonazepam	6–8 mg per day	Sedation, ataxia, memory impairment, withdrawal	NA
Valproate	500–1500 per day	Weight gain, hair loss, nausea, hepatotoxicity, pancreatitis, fetal malformations, thrombocytopenia	Total and free valproate level, LFTs, CBC, ammonia
Misoprostol	600 µg per day	Diarrhea, GI discomfort, menorrhagia	NA