Quantcast

Less common anticonvulsants for neuropathic pain states

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Timeoutofmind

Full Member
7+ Year Member
Joined
Apr 6, 2013
Messages
822
Reaction score
405

Members don't see this ad.
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?
 

lobelsteve

Full Member
Staff member
Volunteer Staff
Lifetime Donor
15+ Year Member
Joined
May 30, 2005
Messages
18,167
Reaction score
8,708
Elavil, Pamelor, Doxepin, Topamax, Keppra, Trileptal, Gralise, gabapentin, Horizant, Lyrica, Cymbalta, Savella, Effexor, Zonegran.

Others: Lamictal, Mexilitine, Tegretol, Dapsone.
 

Orin

Full Member
10+ Year Member
Joined
Jul 27, 2009
Messages
1,399
Reaction score
751
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?
 

Tapspatellas

Full Member
10+ Year Member
Joined
Oct 12, 2009
Messages
293
Reaction score
66
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.
 

unchockey21

Full Member
15+ Year Member
Joined
Apr 2, 2007
Messages
290
Reaction score
161
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.
 

Ducttape

Full Member
Lifetime Donor
10+ Year Member
Joined
Oct 7, 2011
Messages
11,899
Reaction score
4,360
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.
 
  • Like
Reactions: 1 user

melancholy

1K Member
15+ Year Member
20+ Year Member
Joined
Nov 20, 2000
Messages
1,713
Reaction score
66
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.
 
Top