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Drug Starting dose Usual effective dose Multipurpose Analgesics Antidepressants Tricyclic antidepressants     Amitriptyline (Elavil®) 10–25 mg HS 50–150 mg HS     Nortriptyline (Pamelor®) 10–25 mg HS 50–150 mg HS     Desipramine (Norpramin®) 10–25 mg HS 50–150 mg HS Selective serotonin reuptake inhibitors     Paroxetine (Paxil®) 10–20 mg qd 20–40 mg qd     Citalopram (Celexa®) 10–20 mg qd 20–40 mg qd Noradrenaline/serotonin reuptake inhibitors     Venlafaxine (Effexor®) 37.5 mg qd 37.5–112.5 mg bida Others     Bupropion (Wellbutrin®) 50–75 mg bid 75–150 mg bid Corticosteroids     Dexamethasone (Decadron®) 1–2 mg qd or bid variable     Prednisone (Deltasone; Orasone®) 7.5–10 mg qd variable 2-adrenergic agonists     Clonidine (Catapres®/ 0.1 mg po qd variable         Catapres®-TTS) 1/2 TTS-1 patch 0.3 mg transdermal/day     Tizanidine (Zanaflex®) 2 mg HS variable Neuroleptics     Olanzapine (Zyprexa®) 2.5 mg qd unclear efficacy     Pimozide (Orap®; Gate Pharmaceuticals; Sellersville, PA) 1 mg qd unclear efficacy Adjuvants for Neuropathic Pain Anticonvulsants     Gabapentin (Neurontin®) 100–300 mg HS 300–1,200 mg tid     Lamotrigine (Lamictal®) 25 mg qd 100–200 mg bid     Oxcarbazepine (Trileptal®) 75–150 mg bid 150–800 mg bid     Topiramate (Topamax®) 25 mg qd 100–200 mg bid     Pregabalin 150 mg qd 300–600 mg bid     Levetiracetam (Keppra®) 250–500 mg bid 500–1,500 mg bid     Tiagabine (Gabitril®) 4 mg HS 4–12 mg bid     Zonisamide (Zonegran®) 100 mg qd 100–200 mg bid     Carbamazepine (Carbatrol®; Tegretol®) 100–200 mg qd-bid 300–800 mg bid     Valproic acid (Depakene®) 250 mg tid 500–1,000 mg tid     Phenytoin (Dilantin®) 300 mg HS 100–150 mg tid Local anesthetics     Mexiletine (Mexitil®) 150 mg qd 100–300 mg tid     Lidocaine intravenous (Xylocaine®) 2 mg/kg over 30 minutes 2–5 mg/kg     Lidocaine topical (Lidoderm®) 1–3 patches 12 hours/24 N-methyl-D-aspartate receptor antagonists     Ketamine different regimen (see text)     Dextromethorphan 15–20 mg tid unclear     Amantadine (Symmetrel®) 100 mg qd 100–150 mg bid Adjuvant analgesics for bone pain Corticosteroids Calcitonin (Miacalcin®) 1 IU/kg s.c. qd 200 IU intranasal qd Bisphosphonates     Pamidronate (Aredia®) 60 mg i.v. q monthb 60–90 mg i.v. q monthb     Zoledronic acid (Zometa®) 4 mg i.v. q 3 weeks Radiopharmaceuticals Adjuvant analgesics for musculoskeletal pain Muscle relaxants     Cyclobenzaprine (Flexeril®) 5 mg tid 10–20 mg tid     Orphenadrine (Norflex®) 100 mg bid 100 mg bid     Carisoprodol (Soma®) 350 mg HS-tid 350 mg tid-qid     Metaxalone (Skelaxin®) 400 mg tid-qid 800 mg tid-qid     Methocarbamol (Robaxin®) 500 mg qid 500–750 mg qid Tizanidine 2 mg HS variable Baclofen 5 mg tid 10–20 mg tid Benzodiazepines     Diazepam (Valium®) 1 mg bid 2–10 mg bid-qid     Lorazepam (Ativan®) 0.5–1 mg bid 1–2 mg bid-tid     Clonazepam (Klonopin®) 0.5 mg tid 1–2 mg tid Adjuvant analgesics for pain from bowel obstruction Octreotide (Sandostatin®) 0.3 mg/day s.c. infusion Anticholinergics     Hyoscine (scopolamine) 40 mg/day s.c. infusion 60 mg/day s.c. infusion     Glycopyrrolate (Robinul®) 0.1 mg s.c. or i.v. 0.2 mg s.c. or i.v. 3–4 times/day 3–4 times/day Corticosteroids     Dexamethasone (Decadron®) 4 mg bid variable     Methylprednisolone (Solu-Medrol®) 10 mg tid 10–20 mg tid Other adjuvant analgesics Baclofen (Lioresal®) 5 mg tid 10–20 mg tid Cannabinoids     Dronabinol (Marinol®) 2.5 mg bid 5–10 mg bid Psychostimulants     Methylphenidate (Metadate CD®; Methylin®; Ritalin®) 2.5 mg q a.m. variable     Modafinil (Provigil®) 100 mg q a.m. variable aThe extended-release formulation should be administered once daily. bPamidronate should be infused over 2–4 hours. Abbreviations: qd = once a day; bid = twice a day; tid = three times a day; HS = every night; q = every; po = orally.

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