| 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. |
