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Table 193-2

Treatment of Painful Sensory Neuropathies

TherapyRouteDoseSide Effects
First-Line
Lidoderm 5% patchApply to painful areaUp to 3 patches qdSkin irritation
Tricyclic antidepressants (e.g., amitriptyline, nortriptyline)PO10-100 mg qhsCognitive changes, sedation, dry eyes and mouth, urinary retention, constipation
GabapentinPO300-1200 mg tidCognitive changes, sedation, peripheral edema
PregabalinPO50-100 mg tidCognitive changes, sedation, peripheral edema
DuloxetinePO30-60 mg qdCognitive changes, sedation, dry eyes, diaphoresis, nausea, diarrhea, constipation
Second-Line
CarbamazepinePO200-400 mg q 6-8 hCognitive changes, dizziness, leukopenia, liver dysfunction
PhenytoinPO200-400 mg qhsCognitive changes, dizziness, liver dysfunction
VenlafaxinePO37.5-150 mg/dAsthenia, sweating, nausea, constipation, anorexia, vomiting, somnolence, dry mouth, dizziness, nervousness, anxiety, tremor, and blurred vision as well as abnormal ejaculation/orgasm and impotence
TramadolPO50 mg qidCognitive changes, gastrointestinal upset
Third-Line
MexiletinePO200-300 mg tidArrhythmias
Other Agents
EMLA creamApply cutaneouslyqidLocal erythema
2.5% lidocaine
2.5% prilocaine
Capsaicin 0.025-0.075% creamApply cutaneouslyqidPainful burning skin

Source: Modified from AA Amato, J Russell: Neuromuscular Disease. New York, McGraw-Hill, 2008.