Treatment of Painful Sensory Neuropathies
Therapy | Route | Dose | Side Effects |
---|---|---|---|
First-Line | |||
Lidoderm 5% patch | Apply to painful area | Up to 3 patches qd | Skin irritation |
Tricyclic antidepressants (e.g., amitriptyline, nortriptyline) | PO | 10-100 mg qhs | Cognitive changes, sedation, dry eyes and mouth, urinary retention, constipation |
Gabapentin | PO | 300-1200 mg tid | Cognitive changes, sedation, peripheral edema |
Pregabalin | PO | 50-100 mg tid | Cognitive changes, sedation, peripheral edema |
Duloxetine | PO | 30-60 mg qd | Cognitive changes, sedation, dry eyes, diaphoresis, nausea, diarrhea, constipation |
Second-Line | |||
Carbamazepine | PO | 200-400 mg q 6-8 h | Cognitive changes, dizziness, leukopenia, liver dysfunction |
Phenytoin | PO | 200-400 mg qhs | Cognitive changes, dizziness, liver dysfunction |
Venlafaxine | PO | 37.5-150 mg/d | Asthenia, sweating, nausea, constipation, anorexia, vomiting, somnolence, dry mouth, dizziness, nervousness, anxiety, tremor, and blurred vision as well as abnormal ejaculation/orgasm and impotence |
Tramadol | PO | 50 mg qid | Cognitive changes, gastrointestinal upset |
Third-Line | |||
Mexiletine | PO | 200-300 mg tid | Arrhythmias |
Other Agents | |||
EMLA cream | Apply cutaneously | qid | Local erythema |
2.5% lidocaine | |||
2.5% prilocaine | |||
Capsaicin 0.025-0.075% cream | Apply cutaneously | qid | Painful burning skin |
Source: Modified from AA Amato, J Russell: Neuromuscular Disease. New York, McGraw-Hill, 2008.