DRUG

STARTING ORAL DOSE

SPECIFIC INDICATIONS

POTENTIAL ADVERSE EFFECTS

PRECAUTIONS AND RECOMMENDATIONS

Corticosteroids, e.g., prednisone

2.5-5 mg daily

Inflammatory diseases

Hyperglycemia, osteo-penia, Cushingâs

Avoid high dose for long-term use

Tricyclic Antidepressants, e.g. amitriptyline, desipramine, doxepin, imipramine, nortriptyline

10 mg HS

Neuropathic pain, sleep disturbance

Increased sensitivity to side effects, especially anticholinergic effects

Monitor carefully for anticholinergic side effects; desipramine may be as effective as amitriptyline with fewer side effects; start at lowest available dose (10 mg) and titrate HS dose upward by 10 mg every 3-5 days; schedule frequent follow-up visits

Anticonvulsants

Neuropathic pain

Clonazapam

0.25-0.5 mg

Sedation, balance disturbance

Carbamazapine

100 mg

Trigeminal neuralgia

Somnolence, ataxia, dizziness, leukopenia, thrombocytopenia, rarely aplastic anemia

Start at 100 mg qd, increase slowly bid, 200 mg qd, then bid; check LFTs, CBC, Cr/BUN at baseline; CBC at 2 and 8 weeks

Gabapentin

100 mg

Ataxia, ankle swelling, nausea

Appears to have less serious side effects than carbamazapine; titrate slowly to effective dose vs. side effects (up to 35 mg/kg/day)

Antiarrhythmics, e.g., mexiletine

150 mg

Neuropathic pain

Tremor, dizziness, ataxia, rarely blood dyscrasias, hepatotoxicity

Avoid use in patients with exigent or potential for conduction defects or block; start with low dose and titrate slowly to 10-15 mg/kg/day tid dosing; recommend initial and follow-up EKGs

Other Agents

Baclofen

5 mg

Neuropathic pain, muscle spasms

Sedation, weakness, ataxia

Monitor for urinary dysfunction; discontinue via tapering to avoid possibility of CNS irritability withdrawal seizures; titrate slowly up to 1 mg/kg day tid dosing balancing therapeutic effects vs. toxicity