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Last Updated 09/15/06
 
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DRUG TREATMENTS FOR
FACIAL NEURALGIAS

Disclaimer.

According to Joanna M. Zakrzewska, MD, head of the Department of Oral Medicine at St., Bartholomew's and the Royal London School of Medicine and Dentistry, only 12 controlled trials on the effects of certain medications on trigeminal neuralgia have been conducted, among them Tegretol, Pimozide, Lamotrigine and Baclofen.

The drugs used to treat trigeminal neuralgia and related conditions are divided into five groups.

The National Institute of Neurological Disorders and Stroke (NINDS) has written a simple introduction to pain medications. Though applicable to neurological pain syndromes in general, the article contains good specific references to TN medications as well. See Treatment Options for Chronic Pain .

  Drug Assistance Programs  
The pharmaceutical industry has had a long-standing tradition of providing prescription medicines free of charge to physicians whose patients might not otherwise have access to necessary medicines. The following website give information about what medicines are covered  and eligibility criteria.


Anticonvulsants

Anticonvulsants are usually the most effective drugs for treating classical TN pain. Unfortunately, these drugs tend to have serious side effects, including effects on the blood levels.

The most usual anticonvulsant used for TN still appears to be carbamazepine. The other anticonvulsants appear to be mainly in experimental use. The differences between them are small, and the choice of one over another is somewhat arbitrary. They appear to be most often used when the side effects of carbamazepine are found to be too disagreeable.

Carbamazepine. (Tegretol,Epitol). Most commonly used used for TN

Carbatrol - Time-released Tegretol

Clonazepam. (Klonopin,Rivatril)

Gabapentin. (Neurontin).

Lamotrigin. (Lamictal).

Oxcarbazepine. (Trileptal)

Phenytoin.(Dilantin).


Antidepressants

Antidepressants tend to be particularly effective for atypical forms of TN. Especially good results are obtained when antidepressants are used together with anticonvulsants. Tricyclic antidepressants are most commonly used. Their problem is serious side effects, including weight gain. Therefore, other types of antidepressants are being investigated.

Amitriptyline. (Elavil). The most commonly used tricyclic antidepressant.

Protriptyline (Vivactil)

Nortriptyline (Pamelor)

Fluoxetine. (Prozac, Seronil, Fontex,...).

Trazodone. (Desyrel).

 


Anti-spasticity drugs

Anti-spasticity drugs are somewhat related to anticonvulsants, but act on the muscles rather than the nerves themselves.  They can be effective in the early stages of TN and are often used in conjunction with other drugs, especially tegretol.  They help reduce the spasms that TN often causes. In particular, atypical TN sufferers may benefit from these drugs.

Baclofen. (Lioresal)


Painkillers

The most hellish thing about TN is that few ordinary painkillers are effective for the pain. Even moderately strong opiates often do not help, let alone over-the-counter NSAIDS (nonsteroidal anti-inflammatory drugs such as aspirin). These drug groups thus cannot be considered to be in the mainstream for relieving TN pain, but are included here for completeness.

NSAIDS.

Opioids.

Other analgesics.


Experimental Medications

There are some drugs that could have conceivable effects on TN, but no official link has yet been established. It is very important to note that the some of the drugs in this category have not been medically tested for TN. 

Amerge  A migraine medication. Anecdotal use for TN .

Cafergot. A migraine medication. Anecdotal use for TN

Mexiletine. Ordinarily used for heart rhythm problems. Also in experimental use for neuropathic pain. Use for TN pain has been suggested.

Misoprostol (Cytotec). This anti-ulcer drug shows promise for patients whose TN is the result of multiple sclerosis.

Pimozide (Orap). Used primarily for chronic schizophrenia and Tourette's Syndrome. Use for TN has also been suggested.

Sumatriptan. Used for migraines and cluster headaches.

Valproic acid.  A new epilepsy and migraine drug. Use for TN is experimental.

 

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