test announcement
Capsaicin cream unlicensed (Drugs for relief of soft-tissue disorders and topical pain relief) is used in post-herpetic neuralgia, carbamazepine (Antiepileptics) in trigeminal neuralgia and pregabalin (Antiepileptics) in neuropathic pain – see note box below.Note Fibromyalgia: Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain
• Note: Pregabalin should be restricted to use for peripheral neuropathic pain in adults who have not responded to or tolerated conventional first and second-line treatments. Discontinue treatment if the patient has not shown sufficient benefit within 8 weeks of reaching the maximally tolerated therapeutic dose. Optimise tablet strength and use twice-daily dosing to minimise cost. Restrict use of the oral solution to those patients who find it difficult to or are unable to swallow tablets. See Antiepileptics for antiepileptic use.• Note: Gabapentin and pregabalin have the potential for misuse and careful review of some patients’ motivation in asking for them is required; refer to SIGN 136 Management of chronic pain (www.sign.ac.uk).
Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain.
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Oral solution 25mg/5mL, 50mg/5mL off-label
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Tablets 10mg, 25mg off-label
Neuropathic pain if amitriptyline is poorly tolerated: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
The levels of propylene glycol, acesulfame K and saccharin sodium may exceed the recommended WHO daily intake limits if high doses of gabapentin oral solution (Rosemont brand) are given to adolescents or adults with low body-weight (39 to 50kg)—consult product literature.
MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019) (www.gov.uk).
MHRA advice: Gabapentin (Neurontin®): risk of severe respiratory depression (October 2017) (www.gov.uk).
Capsules (CD schedule 3) 100mg, 300mg, 400mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
Tablets (CD schedule 3) 600mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
MHRA advice: Duloxetine: marketed as Cymbalta▼ and Yentreve▼ for different disorders (December 2014) (www.gov.uk).
Diabetic peripheral neuropathic pain after failure of simple analgesics and local measures, and where treatment with amitriptyline (uptitrated) and then with gabapentin has been ineffective or unsuitable: 60mg once daily.
If ineffective, some patients may benefit from 60mg twice daily maximum. Discontinue if inadequate response after 2 months; review treatment at least every 3 months.
TAM (Treatments and Medicines) NHS Highland