Usual Effective Dose (and Maximum)
50-150 mg/d; median 50-75 mg/d
50 mg/d (maximum 400 mg/d)
60 mg/d (maximum 120 mg/d)
75-225 mg/d (maximum 225 mg/d)
200-1200 mg/d (maximum 1200 mg/d); for trigeminal neuralgia, controlled-release CBZ q8-12h, with short-acting CBZ q4h for rescue
(maximum 375 mg/d)
Comments
• More adverse effects with amitriptyline and imipramine
• Contraindicated in patients with glaucoma and those taking MAOIs
• Dose adjustment in patients with renal dysfunction • Contraindicated in patients taking MAOIs
• Contraindicated in patients with glaucoma and those taking MAOIs or other serotonin enhancing meds
• Recent US FDA approval for use in diabetic neuropathy
• Dose adjustment in patients with renal dysfunction • Contraindicated in patients taking MAOIs
• First-line therapy for trigeminal neuralgia only • Contraindicated in patients with porphyria or atrioventricular block and in those taking MAOIs • Monitor CBC, liver function test results and blood levels
600 mg/d 100-200 mg bid (maximum 60 mg/kg/d)
200-400 mg/d (maximum 400 mg/d)
(maximum 600 mg/d; 700 on day 1)
Benefits of daily morphine equivalents >180 mg/d have not been established
• Screen patients for alcohol/substance abuse and consider "opioid agreement"
• Co-administer pre-emptive stool softeners, cathartic laxatives, and antiemetics
• Use with caution in patients with epilepsy
