Drug regimens for adults with acute neuropathic pain managed in hospital
For patients with acute neuropathic pain managed in hospital (eg major burns), doses of oral adjuvants are titrated quickly to achieve faster analgesia and adverse effects are managed simultaneously; if an oral adjuvant is appropriate use:
1 gabapentin 100 to 300 mg orally, at night on day 1. Increase the dose to twice daily on day 2, 3-times daily on day 3, then increase every 3 days, as tolerated and according to response, up to 3600 mg daily. If the patient is frail or older than 70 years, use the lower end of the dose range initially, titrate more slowly and do not exceed 900 mg in 24 hours1 acute pain, neuropathic (in hospital) gabapentin
OR
1 pregabalin 25 to 75 mg orally, at night on day 1. Increase the dose to twice daily on day 2, then increase every 3 days, as tolerated and according to response, up to 600 mg daily. If the patient is frail or older than 70 years, use the lower end of the dose range initially, titrate more slowly and do not exceed 300 mg in 24 hours2 acute pain, neuropathic (in hospital) pregabalin
OR
2 amitriptyline 5 to 25 mg orally, at night initially. Increase every 3 days, as tolerated and according to response, up to 50 mg at night. If no pain relief is achieved, discontinue treatment. If some pain relief is achieved, continue to increase the dose every 3 days, as tolerated and according to response, up to 150 mg at night. If the patient is frail or older than 70 years, use the lower end of the dose range initially and titrate more slowly acute pain, neuropathic (in hospital) amitriptyline
OR
2 nortriptyline 10 to 25 mg orally, at night initially. Increase every 3 days, as tolerated and according to response, up to 50 mg at night. If no pain relief is achieved, discontinue treatment. If some pain relief is achieved, continue to increase the dose every 3 days, as tolerated and according to response, up to 150 mg at night. If the patient is frail or older than 70 years, use the lower end of the dose range initially and titrate more slowly acute pain, neuropathic (in hospital) nortriptyline
OR
2 duloxetine 30 mg orally, in the morning. Increase every 3 days, as tolerated and according to response, up to 120 mg in the morning acute pain, neuropathic (in hospital) duloxetine
OR
2 venlafaxine modified-release 37.5 to 75 mg orally, in the morning. Increase every 3 days, as tolerated and according to response, up to 225 mg in the morning. acute pain, neuropathic (in hospital) venlafaxine