Table 5

Preventive treatments in trigeminal neuralgia (adapted from Bendtsen et al 41)

DrugInitiating doseTitration*Dose rangeFrequencyTapering†Specific side effects
Carbamazepine200 mg200 mg every 3 days200–1200 mgTwo to four times per day200 mg every 7 daysDizziness, drowsiness, fatigue, ataxia, diplopia, nausea, cognitive slowing, hyponatraemia leucopenia, thrombocytopenia, skin reactions, abnormal liver function tests
Oxcarbazepine300 mg300 mg every 3 days300–1800 mgFour times per day300 mg every 7 daysDizziness, drowsiness, fatigue, nausea, ataxia, hyponatraemia, skin reaction
Lamotrigine25 mg25 mg for 2 weeks, 50 mg for 1 week, then increase by 50 mg every week25–400 mgTwo times per day50 mg every 7 daysDizziness, drowsiness, fatigue, headache, gastrointestinal symptoms, irritability, sleep disorders, tremor, cognitive slowing, rash
Gabapentin300 mg300 mg every 3 days300–3600 mgThree times per day300 mg every 7 daysDizziness, confusion, fatigue, ataxia, increased risk of infection, gastrointestinal symptoms, weight gain; use cautiously with opioids
Pregabalin150 mg150 mg every 7 days150–600 mgTwo times per day100 mg every 7 daysDizziness, confusion, ataxia, increased risk of infection, gastrointestinal symptoms, weight gain
Baclofen15 mg15 mg every 7 days15–90 mgThree times per day15 mg every 7 daysConfusion, dizziness, drowsiness, gastrointestinal symptoms, euphoria, hallucinations
Botulinum toxin type A25–195 unitsNA25–195 unitsEvery 12 weeksNATransient facial asymmetry, transient bruising at injection site, transient drooling and difficulty chewing
  • *The doses can be increased at a slower rate to improve tolerability; the doses are increased until the pain is well controlled, significant side effects intervene or the maximum dose is achieved.

  • †The doses can be reduced more gradually and in smaller decrements; the dose is reduced to either the minimum required to control the pain or allow cessation of drug without recurrence of pain.

  • NA, not applicable.