Managing Postherpetic Neuralgia With Medications
Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants are often the first type of drug given to patients suffering from postherpetic neuralgia. The TCA amitriptyline (Elavil®, Endep®) was commonly prescribed in the past. Despite its effectiveness, it has a high rate of side effects. Desipramine (Norpramin®) and nortriptyline (Pamelor®) have fewer side effects and are therefore better choices for older adults, the group most likely to have postherpetic neuralgia.
Common side effects of tricyclic antidepressants include dry eyes and mouth, constipation, and grogginess. People with heart arrhythmias, previous heart attacks, or narrow angle glaucoma should generally use a different class of drugs.
Some drugs that reduce seizures can also treat postherpetic neuralgia, because seizures and pain both involve abnormally increased firing of nerve cells. An antiseizure medication called carbamazepine (Epitol®, Tegretol®, Teril®, and others) is effective for postherpetic neuralgia but has rare, potentially dangerous side effects. A newer anticonvulsant, gabapentin (Neurontin®), is prescribed far more often. Side effects of the drug include drowsiness or confusion, dizziness, and sometimes ankle swelling. Another antiseizure medication approved for treating postherpetic neuralgia include pregabalin (Lyrica®)
Opioids are strong pain medications used for all types of pain. They include oxycodone (Roxicodone®, OxyIR®), morphine (MSIR®), tramadol (Ultram®), and methadone (Dolophine®). Opioids can have side effects -- including drowsiness, mental dulling, and constipation -- and can be addictive, so their use must be monitored carefully in those with a history of addiction.