NEUROPATHIC PAIN MANAGEMENT‒ DOSING
Listed therapeutic range Start low; titrate up slowly over weeks
SNRIs Venlafaxine 37.5‒225 mg daily PO Duloxetine 60‒120 mg daily PO LIDOCAINE Lidocaine 5 % patch: Apply 1 -3 patches daily ( local effect only ) Lidocaine IV ( 2 gm / 500 mL ) D
ANTIEPILEPTICS Ca 2+ CHANNEL BLOCKADE
Gabapentin 900‒3600 mgPO / 24 hrdiv q8H Pregabalin 200‒600 mg PO / 24 hr div q8-12H Na + CHANNEL BLOCKADE Carbamazepine D 800‒1200 mg PO/24 hr div q8-12H Na + /Ca 2+ CHANNEL BLOCKADE Lamotrigine N 200‒400 mg PO/24 hr div q12H Topiramate N 200‒400 mg PO/24 hr div q12H OTHER Levetiracetam 1000‒3000 mg PO/IV/24 hr div q12H Valproic acid D 1000‒2000 mg PO/IV daily or div q12H TRICYCLICS TERTIARY AMINE ( More sedating ) Amitriptyline 10-150 mg PO daily Imipramine 10-150 mg PO daily SECONDARY AMINE ( Less sedating, preferred ) Nortriptyline 10-100 mg PO daily ( Amitriptyline metabolite ) Desipramine 10-150 mg PO daily ( Imipramine metabolite ) N = NMDA receptor antagonism D = Monitor drug levels for toxicity div = In divided doses J. Mangham, PharmD 6/08
• Loading dose: 2 mg/kg IV over 15-20 min • Then continuous infusion at 1 mg/kg/hr • Check Lidocaine plasma level 8‒10 hr after start of infusion, target 2‒6 mcg/mL OPIOIDs Dosing is based on pain assessment and management cards. STRONG MU AGONIST STRONG KAPPA AGONIST Morphine Oxycodone Fentanyl Hydromorphone Methadone N WEAK Mu AGONIST ( with 5HT 3 / NE reuptake inhibition ) Tramadol 100‒400 mg PO / 24 hr div q6H Tramadol ER 100 - 300 mg PO daily Tramadol / acetaminophen ( 37.5mg / 325 mg ) 4‒8 tablets PO / 24 hr div q6H
15 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024
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