eMedicine Specialties > Neurology > Electromyography and Nerve Conduction Studies
Ulnar Neuropathy: Treatment & Medication
Updated: Dec 11, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Vasculitic and metabolic evaluation with treatment of underlying condition
- Trials of various classes of pain medications in cases of significant pain or sensory symptoms
- Nonsteroidal anti-inflammatory drugs (NSAIDs, many classes)
- Tricyclic antidepressants
- Anticonvulsants
- Occupational therapy and work hardening programs with design of splints or cushions
Surgical Care
- Surgical exploration in patients with symptoms of intractable and/or if progressive weakness/atrophy, with resection of masses/cysts or sectioning of fibrous bands
- Specific surgical techniques such as medial epicondylectomy, simple release of the flexor carpi ulnaris aponeurosis, and anterior transposition of the nerve48
- Correction or stabilization of obvious trauma sites
- Entrapments in Guyon canal2
Much more detail on the surgical approaches to these problems may be found in Ulnar Nerve Entrapment13 and Cubital Tunnel Syndrome49 .
Consultations
Depending upon etiology, symptoms, and signs, referral to a neurosurgeon, hand surgeon, pain specialist, internist, physiatrist, rheumatologist, occupational therapist, and/or alternative medicine specialist may be appropriate.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Tricyclic antidepressants (TCA)
TCAs are effective in painful paresthesias. While the dosages are similar, the drugs in this category vary in their sedative properties. Amitriptyline can be used if the patient suffers from insomnia, while nortriptyline and desipramine are better choices when sedation becomes a problem.
Amitriptyline (Elavil)
By inhibiting reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase their synaptic concentrations in CNS. Dose may be increased slowly up to maximum of 125 mg/d. If no response, different TCA may be of benefit, but more often drugs from different category such as anticonvulsants are preferable.
Adult
Starting dose: 10-25 mg PO qhs; increase as needed and tolerated in 3- to 7-d intervals and 25-mg steps up to maximum of 125 mg qhs; at doses >75 mg obtain ECG to rule out atrioventricular block
Pediatric
Children: 0.1 mg/kg PO qhs; increase, as tolerated, over 2-3 wk to 0.5-2 mg/kg qhs
Adolescents: Starting dose of 25 mg PO qhs; increase gradually to 100 mg qhs
Metabolized by P450 2D6 system; drugs that inhibit this enzyme system (eg, cimetidine, quinidine) may increase levels; phenobarbital may increase metabolism of amitriptyline and decrease efficacy; blocks uptake of guanethidine and prevents its hypotensive actions; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram
Documented hypersensitivity; atrioventricular block; MAOIs or fluoxetine in past 14 d
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Use with caution in patients with cardiac conduction disturbances and those with history of hyperthyroidism, renal or hepatic impairment; cue to its pronounced effects in cardiovascular system, best to avoid in elderly patients
Nortriptyline (Aventyl HCl, Pamelor)
Has demonstrated effectiveness in treatment of chronic pain. By inhibiting reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, may increase synaptic concentrations in CNS.
Pharmacodynamic effects, such as desensitization of adenyl cyclase and down-regulation of beta-adrenergic receptors and serotonin receptors, also appear to play role in its mechanisms of action.
Adult
Starting dose: 10-25 mg PO qhs; increase as needed and tolerated in 3- to 7-d intervals and in 25-mg steps to maximum of 125 mg qhs; at doses >75 mg obtain ECG to rule out atrioventricular block
Pediatric
<25 kg: Not established
25-35 kg: 10-20 mg PO qhs
35-54 kg: 25-35 mg PO qhs
>25 kg: Administer as in adults
Cimetidine may increase levels; may increase prothrombin time in patients whose PT is stabilized with warfarin
Documented hypersensitivity; atrioventricular block; MAOIs or fluoxetine in past 14 d
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in patients with cardiac conduction disturbances and those with history of hyperthyroidism, renal or hepatic impairment; due to its pronounced effects in cardiovascular system, best to avoid in elderly patients
Duloxetine (Cymbalta)
Indicated for diabetic peripheral neuropathic pain. Potent inhibitor of neuronal serotonin and norepinephrine reuptake.
Adult
60 mg PO qd; may initiate with lower dose in patient unable to tolerate 60 mg/d
Pediatric
Not established
Metabolized by CYP1A2 and CYP2D6; coadministration with drugs that inhibit CYP1A2 (eg, fluvoxamine, cimetidine, ciprofloxacin, enoxacin) may increase duloxetine blood levels and toxicity; coadministration with drugs that inhibit CYP2D6 (eg, paroxetine, fluoxetine, quinidine) may increase duloxetine blood levels and toxicity; duloxetine moderately inhibits CYP2D6 and may decrease elimination of CYP2D6 substrates (eg, tricyclic antidepressants, phenothiazines [eg, thioridazine], type 1C antiarrhythmics [eg, propafenone, flecainide]); coadministration with MAOIs may cause serious, sometimes fatal reactions that include hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes including extreme agitation, delirium, and coma (see Contraindications)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Observe closely for clinical worsening and suicidality when initiating treatment or following dosage change; gradually decrease dose when discontinuing, do not abruptly discontinue; caution with hepatic impairment or end-stage renal disease; recommended not to prescribe to patients with substantial alcohol use or evidence of chronic liver disease; may cause slight blood pressure increase; may activate mania or hypomania; common adverse effects include nausea, dry mouth, constipation, decreased appetite, fatigue, somnolence and increased sweating
Anti-arrhythmic/local anesthetics
Mexiletine, which has been used in various forms as an antiarrhythmic and local anesthetic, tends to blunt some of the stinging and burning of neuropathic pain in some patients.
Mexiletine (Mexitil)
An orally active local anesthetic drug structurally related to lidocaine. May operate by reducing spontaneous discharges from damaged primary small nerve fibers; recommended only in intractable cases; can be used for both dysesthetic and paresthetic pain.
Adult
225-675 mg/d PO
Pediatric
Not established
Medications that decrease mexiletine levels include aluminum-magnesium hydroxide compounds, atropine, narcotics, hydantoins, rifampin, and urinary acidifiers; metoclopramide and urinary alkalinizers may increase mexiletine levels; cimetidine can either increase or decrease mexiletine levels; medications with levels that are increased by mexiletine include caffeine and theophylline
Documented hypersensitivity; mexiletine is contraindicated in those with cardiogenic shock or who have second- or third-degree AV block (without a pacemaker)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
As previously noted, second- or third-degree AV block (without a pacemaker) is a contraindication; can be cautiously used in patients who have pacemakers and second- or third-degree block, in those with first-degree AV blocks, sinus node dysfunction, intraventricular conduction abnormalities, hypotension, or congestive heart failure (cardiology consultation is recommended before using this medication in any of these medical conditions); liver injury reported, particularly in conjunction with congestive heart failure or cardiac ischemia; monitor liver enzymes; rarely leukopenia or agranulocytosis has been seen; CBC should be monitored; convulsions have occurred in about 0.2% of patients on this medication, thus, caution is indicated if there is history of seizures; avoid other drugs, which significantly modify the pH of urine
Alpha-adrenergic agonists
These agents stimulate alpha2-adrenoreceptors in brain stem and activates an inhibitory neuron.
Clonidine (Catapres)
A central alpha-adrenergic agonist that stimulates alpha2-adrenoreceptors in brain stem and activates an inhibitory neuron, resulting in decrease in vasomotor tone and heart rate.
Helpful in controlling withdrawal symptoms during tapering of opioids, which may take 2-3 wk.
Adult
0.1 mg PO tid; reference range is 0.2-0.4 mg/d
Pediatric
Not established
Tricyclic antidepressants inhibit hypotensive effects of clonidine; coadministration of clonidine with beta-blockers may potentiate bradycardia; tricyclic antidepressants may enhance hypertensive response associated with abrupt clonidine withdrawal; hypotensive effects of clonidine are enhanced by narcotic analgesics
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in cerebrovascular disease, coronary insufficiency, sinus node dysfunction, and renal impairment
Narcotics
Although traditionally narcotics have been avoided in peripheral neuropathies, they are useful in many cases.
Morphine sulfate (Astramorph, MS Contin, MSIR, Oramorph)
DOC for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.
Various IV doses are used; commonly titrated until desired effect obtained.
Adult
Starting dose: 0.1 mg/kg IV/IM/SC
Maintenance dose: 5-20 mg/70 kg IV/IM/SC q4h
Relatively hypovolemic patients: Start with 2 mg IV/IM/SC; reassess hemodynamic effects of dose
Pediatric
Infants and children: 0.1-0.2 mg/kg dose IV/IM/SC q2-4h prn; not to exceed 15 mg/dose; may initiate at 0.05 mg/kg/dose
Phenothiazines may antagonize analgesic effects of opiate agonists; tricyclic antidepressants, MAOIs, and other CNS depressants may potentiate adverse effects of morphine
Documented hypersensitivity; hypotension; potentially compromised airway where establishing rapid airway control would be difficult
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hypotension, respiratory depression, nausea, emesis, constipation, urinary retention, atrial flutter, and other supraventricular tachycardias; has vagolytic action and may increase ventricular response rate
Anticonvulsants
Many anticonvulsants are used to alleviate painful dysesthesias, which frequently accompany peripheral neuropathies. Although they have many different mechanisms of action, their use to alleviate neuropathic pain probably depends on the fact that they generally tend to reduce neuronal excitability.
Gabapentin (Neurontin)
Membrane stabilizer, a structural analogue of inhibitory neurotransmitter GABA, which paradoxically is thought not to exert effect on GABA receptors. Appears to exert action via the alpha(2)delta-1 and alpha(2)delta-2 auxiliary subunits of voltage-gated calcium channels.
Used to manage pain and provide sedation in neuropathic pain.
Adult
Standard recommendation: 300 mg/d PO initial; gradually increase; mean dose is 2400 mg/d
Pain recommendation:
Start at low dose as follows to minimize adverse effects:
Days 1-3: 100 mg PO qd
Days 3-5: 100 mg PO bid
Days 6-8: 100 mg PO tid
Week 2: 400 mg PO qd
Week 3: 400 mg PO bid
Week 4: 400 mg PO tid
Following this regimen, increase prn, as tolerated; not to exceed 1200 mg PO tid; recommendation starts lower than standard advice but actually allow one to go higher (up to 1200 mg PO tid); for higher dosages, follow patient very carefully
Pediatric
Not established
Antacids may significantly reduce bioavailability of gabapentin (administer at least 2 h following antacids); may increase norethindrone levels significantly
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Common adverse effects include drowsiness, dizziness, somnolence, and unwanted eye movements; children may experience emotional ability hostility, thought disorder, and hyperkinesia; caution in elderly and patients with severe renal impairment; abrupt withdrawal may precipitate seizures
Pregabalin (Lyrica)
Structural derivative of GABA. Mechanism of action unknown. Binds with high affinity to alpha2-delta site (a calcium channel subunit). In vitro, reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.
Adult
50 mg PO tid initially; if needed, may increase to 100 mg tid within 1 wk
Pediatric
Not established
May cause additive effects on cognitive and gross motor functioning when coadministered with drugs that cause dizziness or somnolence
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue gradually (over a minimum of 1 wk) to minimize increased seizure frequency in patients with seizure disorders; may cause insomnia, nausea, headache, or diarrhea with abrupt withdrawal; common adverse effects include dizziness, somnolence, blurred vision, weight gain, and peripheral edema; may elevate creatinine kinase level, decrease platelet count, and increase PR interval; doses >300 mg/d associated with higher rate of adverse effects and treatment discontinuation; decrease dose with renal impairment (ie, CrCl <60 mL/min)
Lamotrigine (Lamictal)
Triazine derivative useful in treatment of neuralgia. Inhibits release of glutamate and inhibits voltage-sensitive sodium channels, which stabilizes neuronal membrane. Follow manufacturer's recommendation for dose adjustments.
Adult
50-100 mg/d PO divided bid initial dose; 100-400 mg/d qd or divided bid maintenance; not to exceed 500 mg/d
Pediatric
<2 years: Not established
2-12 years:
Weeks 1-2: 0.6 mg/kg/d PO divided bid, rounded down to nearest 5 mg
Weeks 3-4: 1.2 mg/kg/d PO divided bid, rounded down to nearest 5 mg
Maintenance: 5-15 mg/kg/d PO; not to exceed 400 mg/d divided bid; to achieve usual maintenance dose, increase subsequent doses q1-2wk as follows: calculate 1.2 mg/kg/d and round down to nearest 5 mg; add this amount to previously administered daily dose
>12 years:
Weeks 1-2: 50 mg/d PO
Weeks 3-4: 100 mg/d PO divided bid
Maintenance: 300-500 mg/d PO divided bid; to achieve maintenance, increase by 100 mg/d q1-2wk
Acetaminophen increases renal clearance of medication, decreasing effects; similarly, phenobarbital and phenytoin increase lamotrigine metabolism causing a decrease in lamotrigine levels; administration of valproic acid with lamotrigine increases half-life; succinimide anticonvulsants (eg, methsuximide, phensuximide) decrease lamotrigine levels
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in impaired renal or hepatic function; if rash occurs should inform physician
Topiramate (Topamax)
Precise mechanism unknown, but the following properties may contribute to its efficacy: (1) electrophysiological and biochemical evidence showing blockage of voltage-dependent sodium channels, (2) augments the activity of the neurotransmitter GABA at some GABA-A receptor subtypes, (3) antagonizes AMPA/kainate subtype of the glutamate receptor, and (4) inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV.
Adult
Slowly titrate upward at a minimum of 1 week intervals as follows:
Week 1: 25 mg PO qhs
Week 2: 25 mg PO bid
Week 3: 25 mg PO qam and 50 mg PO qhs
Week 4: 50 mg PO bid
Pediatric
Not established
Phenytoin, carbamazepine and valproic acid can significantly decrease topiramate levels; topiramate reduces digoxin and norethindrone levels, when administered concomitantly; concomitant use with carbonic anhydrase inhibitors may increase risk of renal stone formation and should be avoided; use topiramate with extreme caution when administering concurrently with CNS depressants since may have an additive effect in CNS depression, as well as other cognitive or neuropsychiatric adverse events
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Risk of developing a kidney stone formation is increased 2-4 times that of untreated population; risk may be reduced by increasing fluid intake; caution in renal or hepatic impairment; patients taking topiramate should seek immediate medical attention if they experience blurred vision or periorbital pain; continued usage after symptoms develop, can lead to glaucoma; primary treatment is discontinuation of topiramate; if left untreated, serious sequelae, including permanent vision loss, may occur; oligohidrosis and hyperthermia has been reported predominantly in children during vigorous exercise or exposure to warm environmental temperatures (ensure proper hydration prior and during activity and warm temperatures)
May cause hyperchloremic, non-anion gap metabolic acidosis acute or chronic metabolic acidosis resulting in hyperventilation, and nonspecific symptoms, such as fatigue and anorexia, or more severe adverse effects including cardiac arrhythmias or stupor; chronic, untreated metabolic acidosis may increase nephrolithiasis or nephrocalcinosis risk, osteomalacia (ie, rickets in pediatric patients), or osteoporosis with an increased risk for bone fractures; chronic metabolic acidosis in pediatric patients may also reduce growth rates; measure baseline and periodic serum bicarbonate; sprinkle capsules should be swallowed whole or carefully open capsule and sprinkle contents on soft food immediately before ingestion, do not chew or crush
Levetiracetam (Keppra)
Another new anticonvulsant being used to combat pain of peripheral neuropathies. Mechanism that improves condition not known but probably related to fact that anticonvulsants generally reduce nerve irritability. Not FDA approved for this indication.
Adult
Not established
Recommended dosages for seizures:
1000 mg/d PO divided bid (500 mg bid); may increase by 1000 mg/d increments q2wk; not to exceed 3000 mg/d; long-term experience at doses >3000 mg/d is relatively minimal, and there is no evidence that doses >3000 mg/d offer additional benefit
Pediatric
Not established
Recommended dosages for seizures:
Partial onset seizures:
<4 years: Not established
4-15 years: 20 mg/kg/d PO divided bid; may increase by 20 mg/kg/d increments q2wk; not to exceed 60 mg/kg/d; use oral solution if weight <20 kg
>16 years: Administer as in adults
Myoclonic seizures:
<12 years: Not established
>12 years: Administer as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal impairment (reduce dose); major side effects include somnolence, asthenia, incoordination, mild leukopenia (3%) and behavioral changes such as anxiety, hostility, emotional lability, depression and psychosis (1-2%), and depersonalization; seizure frequency may increase following discontinuing drug (discontinue gradually); statistically significant decreases in RBCs and WBCs have been observed
Phenytoin (Dilantin)
Blocks sodium channels nonspecifically and therefore reduces neuronal excitability in sensitized C-nociceptors. Has been demonstrated effective in neuropathic pain but suppresses insulin secretion and may precipitate hyperosmolar coma in patients with diabetes.
Antineuralgic effects may derive from the blocking of posttetanic potentiation by reducing summation of temporal stimulation.
Adult
300 mg PO qhs
Pediatric
5-10 mg/kg/d PO/IV divided bid/tid
Amiodarone, benzodiazepines, chloramphenicol, cimetidine, fluconazole, isoniazid, metronidazole, miconazole, phenylbutazone, succinimides, sulfonamides, omeprazole, phenacemide, disulfiram, ethanol (acute ingestion), trimethoprim, and valproic acid may increase phenytoin toxicity
Phenytoin effects may decrease when taken concurrently with barbiturates, diazoxide, ethanol (chronic ingestion), rifampin, antacids, charcoal, carbamazepine, theophylline, and sucralfate
Phenytoin may decrease effects of acetaminophen, corticosteroids, dicumarol, disopyramide, doxycycline, estrogens, haloperidol, amiodarone, carbamazepine, cardiac glycosides, quinidine, theophylline, methadone, metyrapone, mexiletine, oral contraceptives, valproic acid
Documented hypersensitivity; sinoatrial block, second- and third-degree AV block, sinus bradycardia, or Adams-Stokes syndrome
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Perform blood counts and urinalyses when therapy is begun and at monthly intervals for several months thereafter to monitor for blood dyscrasias; discontinue use if a skin rash appears and do not resume use if rash is exfoliative, bullous or purpuric; rapid IV infusion may result in death from cardiac arrest, marked by QRS widening; caution in acute intermittent porphyria and diabetes (may elevate blood sugars; discontinue use if hepatic dysfunction occurs
Carbamazepine (Tegretol, Carbatrol, Epitol)
A sodium-channel blocker that typically provides substantial or complete relief of pain in 80% of individuals with both idiopathic and MS-associated TN within 24-48 h. Reduces sustained high-frequency repetitive neural firing. Potent enzyme inducer that can induce own metabolism. Due to potentially serious blood dyscrasias, undertake benefit-to-risk evaluation before drug instituted. Therapeutic plasma levels are between 4-12 mcg/mL for analgesic and antiseizure response. Peak serum levels in 4-5 h. Half-life (serum) in 12-17 h with repeated doses. Metabolized in liver to active metabolite (ie, epoxide derivative) with half-life of 5-8 h. Metabolites excreted through feces and urine.
Adult
200 mg PO bid (100 mg PO qid if suspension); increase at weekly intervals by no more than 200 mg/d tid/qid (bid with extended release) until best response obtained; not to exceed 1600 mg/d
Pediatric
<6 years: 10-20 mg/kg/d PO bid/tid (qid with suspension)
Increase weekly to achieve optimal clinical response tid/qid; not to exceed 100 mg/d
6-12 years: 100 mg PO bid (50 mg qid of suspension)
Increase gradually qwk by adding 100 mg/d PO divided tid/qid (bid with extended release) until best response obtained; not to exceed 1000 mg/d
>12 years: Administer as in adults, not to exceed 1000 mg/d in children 12-15 y or 1200 mg/d in those older than 15 y
Serum levels may increase significantly within 30 d of danazol coadministration (avoid whenever possible); do not coadminister with MAOIs; cimetidine may increase toxicity especially if taken in first 4 wk of therapy; carbamazepine may decrease primidone, and phenobarbital levels (their coadministration may increase carbamazepine levels)
Documented hypersensitivity; history of bone marrow depression; administration of MAOIs within last 14 d
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Do not use to relieve minor aches or pains; caution with increased intraocular pressure; obtain CBCs and serum-iron baseline prior to treatment, during first 2 months, and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness
Oxcarbazepine (Trileptal)
Pharmacologic activity primarily by 10-monohydroxy metabolite (MHD). Studies indicate that this drug may block voltage-sensitive sodium channels, inhibit repetitive neuronal firing, and impair synaptic impulse propagation. Anticonvulsant effect also may occur by affecting potassium conductance and high-voltage activated calcium channels. Pharmacokinetics similar in older children (>8 y) and adults. Young children (<8 y) have 30-40% greater clearance than older children and adults. Children <2 y have not been studied in controlled clinical trials. Not FDA approved for this indication.
Adult
600 mg/d PO divided bid initially; increase dose by 300 mg/d every third day to 1200 mg/d; monitor patients for anticonvulsant side effects
Pediatric
<4 years: Not established
4-16 years:
8-10 mg/kg/d PO divided bid; may increase by 5 mg/kg/d q3d to recommended daily dose
Maintenance dose is based on body weight as follows:
20-24 kg: 600-900 mg/kg/d
25-34 kg: 900-1200 mg/kg/d
35-44 kg: 900-1500 mg/kg/d
45-49 kg: 1200-1500 mg/kg/d
50-59 kg: 1200-1800 mg/kg/d
60-69 kg: 1200-2100 mg/kg/d
>70 kg: 1500-2100 mg/kg/d
>16 years: Administer as in adults
May decrease levels of dihydropyridine calcium antagonists and oral contraceptives; can reduce serum concentrations of carbamazepine, phenobarbital, phenytoin and valproic acid; when oxcarbazepine is given in doses above 1200 mg/d may increase phenytoin and phenobarbital serum concentrations significantly; oxcarbazepine can reduce serum concentrations of oral contraceptives and make oral contraceptives ineffective; can increase clearance of felodipine
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Can cause cognitive adverse effects (eg, psychomotor slowing, impaired concentration, impaired speech, impaired language); decrease initiation dose by 50% with renal impairment (CrCl <30 mL/min) and increase dose more slowly; oxcarbazepine can cause hyponatremia (sodium <125 mmol/L); among persons with hypersensitivity to carbamazepine, 25-30% will have hypersensitivity to oxcarbazepine; rapid withdrawal of oxcarbazepine can cause exacerbation of seizures; observe for side effects and monitor plasma levels of concomitant anticonvulsants during dose titration
More on Ulnar Neuropathy |
| Overview: Ulnar Neuropathy |
| Differential Diagnoses & Workup: Ulnar Neuropathy |
 Treatment & Medication: Ulnar Neuropathy |
| Follow-up: Ulnar Neuropathy |
| Multimedia: Ulnar Neuropathy |
| References |
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Further Reading
Keywords
bicycle's neuropathy, cubital tunnel syndrome, Guyon canal syndrome, Guyon's canal syndrome, tardy ulnar palsy, ulnar palsy tarda
