Table 2: Treatment options for PHN Oral administration – Pharmacological Tricyclic Anti-convulsants (with analgesic properties) category Antidepressants Nortriptyline Gabapentin Pregabalin Carbamazepine Drug (Neurontin) (Lyrica) (Tegretol) Dose Start: 10-20mg QD 100mg TID po 75mg QHS BID (Maximum) (600mg TID) (300mg BID) (600mg BID) Limited support for Anti-neuralgic Anti-neuralgic Anti-neuralgic use in conjunction action action action Reason why with anti-virals Highly Highly Often used for considered during acute phase recommended for recommended for treatment of PHN to prevent PHN treatment of PHN treatment of PHN & Trigeminal neuralgia Increased risk for May increase risk May increase risk Contra-indicated for eosinophilia, for leucopenia for patients with bone purpura and May take 2 -3 thrombocytopenia marrow suppression. Warnings / thrombocytopenia weeks to achieve Warning: Reason(s) why May also aggravate optimal hypersensitivity may not selected peripheral effectiveness. mimic signs & neuropathy symptoms of lymphoma Interacts with many Generic available No generic available Interacts with many Other other drugs Very few drug-drug Expensive other drugs considerations interactions Not selected based Most favored Not selected - too Not selected based Final decision on limited support option fewest expensive on side-effect – and side-effect profile for this patient interactions & EBP supported Table 3: Topical preparations / options for treatment of PHN Topical Capsaicin Treatment Lidocaine 5% Topical Aspirin 0.075% cream Patch applied to intact skin Aspirin tablets crushed & Applied to intact skin after How used / after resolution of blisters mixed into Vaseline / crusted lesions are healed applied and crusts Eucerin cream May be useful on buttock Used in many compounded Not considered Reason why once all lesions are topical treatments considered completely healed. Warnings / Patient still has blisters & Not considered for use in Reason(s) why crusted lesions. Patch not perineal / groin area not selected recommended for
Table 2: Treatment options for PHN – Oral administration Pharmacological category Tricyclic Antidepressants Anti-convulsants (with analgesic properties) Drug Nortriptyline Gabapentin (Neurontin) Pregabalin (Lyrica) Carbamazepine (Tegretol) Dose Start: (Maximum) 10-20mg QD 100mg TID po (600mg TID) 75mg QHS (300mg BID) BID (600mg BID) Reason why considered Limited support for use in conjunction with anti-virals during acute phase to prevent PHN Anti-neuralgic action Highly recommended for treatment of PHN Anti-neuralgic action Highly recommended for treatment of PHN Anti-neuralgic action Often used for treatment of PHN & Trigeminal neuralgia Warnings / Reason(s) why not selected Increased risk for eosinophilia, purpura and thrombocytopenia May also aggravate peripheral neuropathy May increase risk for leucopenia May take 2 -3 weeks to achieve optimal effectiveness. May increase risk for thrombocytopenia Contra-indicated for patients with bone marrow suppression. Warning: hypersensitivity may mimic signs & symptoms of lymphoma Other considerations Interacts with many other drugs Generic available Very few drug-drug interactions No generic available Expensive Interacts with many other drugs Final decision for this patient Not selected based on limited support and side-effect Most favored option – fewest interactions & EBP supported Not selected - too expensive Not selected based on side-effect profile Table 3: Topical preparations / options for treatment of PHN Treatment Lidocaine 5% Topical Aspirin Topical Capsaicin 0.075% cream How used / applied Patch applied to intact skin after resolution of blisters and crusts Aspirin tablets crushed & mixed into Vaseline / Eucerin cream Applied to intact skin after crusted lesions are healed Reason why considered May be useful on buttock once all lesions are completely healed. Used in many compounded topical treatments Not considered Warnings / Reason(s) why not selected Patient still has blisters & crusted lesions. Patch not recommended for Not considered for use in perineal / groin area
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