Less common anticonvulsants for neuropathic pain states

[Timeoutofmind]

Gaba/lyrica/topamax are commonly used for neuropathic pain states, as well as antidepressants and topicals.

How about the other anticonvulsants? Does anyone try tegretol or any others before resigning these people to stim?

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[pastafan]

Oxcarbazepine, levetiracetam

 

[lobelsteve]

Elavil, Pamelor, Doxepin, Topamax, Keppra, Trileptal, Gralise, gabapentin, Horizant, Lyrica, Cymbalta, Savella, Effexor, Zonegran.

Others: Lamictal, Mexilitine, Tegretol, Dapsone.

 

[unchockey21]

Gabitril

 

[lobelsteve]

Gabitril

Never worked in 2005. Didnt know it was still on market. Still doesnt work.

 

[Ligament]

Elavil, Pamelor, Doxepin, Topamax, Keppra, Trileptal, Gralise, gabapentin, Horizant, Lyrica, Cymbalta, Savella, Effexor, Zonegran.

Others: Lamictal, Mexilitine, Tegretol, Dapsone.

School me on dapsone for analgesia.

 

[lobelsteve]

School me on dapsone for analgesia.

Its not useful. In 2006 there was a company trying to bring it to market for neuropathy. There have been case reorts of the drug causing neuropathy.

Newer moa data, still would not rx.

 

[Orin]

I thought Keppra had multiple studies showing lack of efficacy and sig side effects for neuropathic pain?

My patients tell me great stuff about something known as Diastat?

 

[BobBarker]

Rectal Valium???

 

[Tapspatellas]

I thought Keppra had multiple studies showing lack of efficacy and sig side effects for neuropathic pain?

My patients tell me great stuff about something known as Diastat?

Studies pretty underwhelming for kept from what I've seen, I'll still give it a go at times, but rarely effective.

Hey if u want the Valium poop shoot, go for some diastat! Shoot, why not some gabastat? Easier than taking all those horse pills TID

Other one I've seen the neurologists start using is lacosamide.

 

[drusso]

Rectal Valium???

Works best with rectal dilaudid suppositories.

 

[unchockey21]

Never worked in 2005. Didnt know it was still on market. Still doesnt work.

I wouldn't have known either until I got a refill request from a pharmacy last year. Considering that was the only time I saw it used all year, I'd agree with it still not working.

 

[unchockey21]

.

 

[bronchospasm]

Rectal Valium???

Maybe the rectal part of this treatment works better than the Valium part

 

[Ducttape]

Elavil, Pamelor, Doxepin, Topamax, Keppra, Trileptal, Gralise, gabapentin, Horizant, Lyrica, Cymbalta, Savella, Effexor, Zonegran.

Others: Lamictal, Mexilitine, Tegretol, Dapsone.

don't forget our favorite (nonanticonvulsant) - alpha lipoic acid.

 

[melancholy]

Keppra seems to work maybe 1 out of every 4-5 patients I try it on. Of course, with people that have mood disorders to begin with, I'm always wondering if they will start to get more irritability and anger issues with Keppra. I always get down on it after a few patients don't tolerate it, then I get surprised when someone does really well on it and it revives my faith in the Keppra train.

I like Steve's list. I hardly use it, but didn't see Depakene on there. OP mentioned Tegretol already.

Usually neurontin has been tried (have to check to see if they actually titrated up to reasonable dose) as well as nortriptyline, so will look at topamax, sometimes trileptal, and maybe an SNRI.

Theoretically Namenda can help due to NMDA antagonism. Haven't had much luck with it though.

Methadone (even at low dose as an adjuvant) could potentially help. Klonopin has some neuropathic analgesic qualities as well.

What kind of neuropathic pain states are we talking about? Peripheral neuropathies or phantom limb pain or radiculopathies?

I have an odd patient or two that seems to get some neuropathic pain relief from RLS meds like Mirapex or Requip.

If they can pay $50-60 bucks, you can get compounded low dose naltrexone 4.5 to 5mg daily and give it a try.

Make sure these patients don't have wildly fluctuating blood sugars esp if diabetic as sometimes neuropathic pain can spike with sugary intake. It's quite enlightening when patients figure out that eating a donut will cause their peripheral neuropathy pain to spike.