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Table 196-2

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 cream

 2.5% lidocaine

 2.5% prilocaine

Apply cutaneouslyqidLocal erythema
Capsaicin 0.025-0.075% creamApply cutaneouslyqidPainful burning skin

Source: Adapted with permission from Amato AA, Russell J (eds): Neuromuscular Disorders, 2nd ed. New York, McGraw-Hill, 2016.