Behavioural Neurology / 2019 / Article / Tab 3

Review Article

Therapeutic Approaches for Peripheral and Central Neuropathic Pain

Table 3

Pharmacological therapeutic options for neuropathic pain.

IndicationsRecommended dosageSide effectsCommentsRef.

First-line drugs
TCAsAll types of NPAmitriptyline: 10-150 mg/dayDry mouth, constipation, urinary retention, orthostatic hypotensionModerate quality of evidence; strong recommendation[2, 12, 13, 36, 74]

GabapentinoidsAll types of NPGabapentin: 300-3600 mg/day
Pregabalin: 150-600 mg/day
Dizziness, sedation, peripheral swellingHigh quality of evidence; strong recommendation[2, 12, 13, 36, 74]

SNRIsAll types of NPDuloxetine: 20-120 mg/day
Venlafaxine: 150-225 mg/day
NauseaHigh quality of evidence; strong recommendation[2, 12, 13, 36, 74]

Anticonvulsants (sodium ion channel blockers)Trigeminal neuralgiaCarbamazepine: 200-400 mg/day
Oxcarbazepine: 300-600 mg/day
Sedation, hepatotoxicity, hyponatraemiaGRADE recommendation is not applicable[2, 12, 13, 36, 74]

Second-line drugs
Weak opioidsAll types of NPTramadol: 25-400 mg/day
Tapentadol: 50-600 mg/day
Nausea, vomiting, constipationModerate quality of evidence; weak recommendation[2, 12, 13, 36, 74]

Topical agentsPeripheral NPLidocaine (5%) plaster
Capsaicin (8%) patch
Erythema, itchingLidocaine (5%) plaster: low quality of evidence; weak recommendation; capsaicin (8%) patch: high quality of evidence; weak recommendation[2, 12, 13, 36, 74]

Third-line drugs
Strong opioidsAll types of NPMorphine: 10-120 mg/day
Oxycodone: 10-120 mg/day
Nausea, vomiting, constipationModerate quality of evidence; weak recommendation[2, 12, 13, 36, 74]

NeurotoxinPeripheral NPBotulinum toxin type APain at injection siteLow quality of evidence; weak recommendation[2, 12, 13, 36, 74]

Abbreviations: NP = neuropathic pain; SNRI = serotonin norepinephrine reuptake inhibitor; TCA = tricyclic antidepressant.

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