Table 2B. Medications Not Approved for DPNP by FDA1 Drug
Dosage Form Recommended Dosage Opioids (mu agonists)3
Oxycodone CR OxyContin®
10, 20, 40 mg tablets
10-60 mg q12h based on effectiveness/tolerability; adjust starting dose downward if hepatic or renal impairment (CrCl < 60 mL/min)
Tramadol Ultram®
50, 100, 500 mg tablets
25 mg/d initially; titrate in increments of 25 mg/d (as separate doses) q3d to 100 mg/d (25 mg qid); thereaſter in increments of 50 mg/d (as tolerated) q3d to 200 mg/d (50 mg qid)
Aſter titration, 50-100 mg q4–6h to max 400 mg/d
If cirrhosis, 50 mg q12h
If CrCl < 30 mL/min, dosing interval q12h to max 200 mg/d
Ultram ER®
100, 200, 300 mg tablets
100 mg/d initially; titrate in increments of 100 mg/d q5d to max 300 mg/d based on effectiveness/tolerability
Topical agents (adjunctive therapy)
Capsaicin Zostrix HP®
Lidocaine Lidoderm®
Topical capsaicin 0.075% cream
5% lidocaine patch
Apply 4 times daily as directed to painful areas
Apply max 3 patches up to 12 h daily to painful areas
■ Treatment-related burning effects for first several weeks
■ Skin irritation may occur
■ Mild opioid and functional SNRI
■ Do not use if severe hepatic impairment or CrCl < 30 mL/min
■ Tablets must be swallowed whole, not crushed or chewed
■ Schedule II controlled substance
■ Tablets must be swallowed whole, not crushed or chewed
■ Mild opioid and functional SNRI
—continued Comments
1 If treatment plan includes these agents, obtain written patient consent. 3
Evaluate patient for possible substance abuse and obtain opioid agreement signed by patient and physician. CR, controlled release; CrCl, creatinine clearance; MAOIs, monoamine oxidase inhibitors; SSRIs, selective serotonin reuptake inhibitors; XR, extended release.
