Femoral Mononeuropathy Medication

Updated: May 18, 2017
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Medication

Medication Summary

In cases of painful neuropathy, neuropathic pain medications, used off-label, may be of benefit. These medications are palliative, not curative. In cases in which femoral neuropathic pain is related to a diabetic neuropathy, certain medications are used on-label.

Among the medications used to address neuropathic pain are the anticonvulsants pregabalin and gabapentin, as well as the antidepressants amitriptyline and duloxetine.

As previously stated, in patients on anticoagulation therapy whose neuropathy is caused by a retroperitoneal hematoma, anticoagulant agents must be stopped until the hematoma has resolved.

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Anticonvulsants, Other

Class Summary

Some agents in this category have shown benefit in the treatment of neuropathic pain.

Pregabalin (Lyrica)

Pregabalin is a structural derivative of gamma-aminobutyric acid (GABA). Its mechanism of action is unknown. The drug binds with high affinity to the alpha2-delta site (a calcium channel subunit). In vitro, it reduces the calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. Pregabalin has been approved by the US Food and Drug Administration (FDA) for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.

Gabapentin (Neurontin)

Gabapentin, a membrane stabilizer, is a structural analogue of the inhibitory neurotransmitter GABA, although, paradoxically, it is thought not to exert an effect on GABA receptors. It appears to exert its action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gaited calcium channels. Gabapentin is used to manage pain and provide sedation in neuropathic pain.

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Antidepressants, TCAs

Class Summary

The analgesic properties of certain agents in this class may improve symptoms associated with neuropathic pain.

Amitriptyline

Amitriptyline is an analgesic for certain chronic and neuropathic pain. It blocks the reuptake of norepinephrine and serotonin, which increases their concentration in the central nervous system (CNS). Amitriptyline decreases pain by inhibiting spinal neurons involved in pain perception. This agent is highly anticholinergic. It is often discontinued because of somnolence and dry mouth. Cardiac arrhythmia, especially in overdose, has been described; monitoring the QTc interval after reaching the target level is advised. Up to 1 month may be needed to obtain clinical effects.

Clomipramine (Anafranil)

Clomipramine is a dibenzazepine compound belonging to the family of tricyclic antidepressants. The drug inhibits the membrane pump mechanism responsible for the uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons.

Clomipramine affects serotonin uptake while it affects norepinephrine uptake when converted into its metabolite desmethylclomipramine. It is believed that these actions are responsible for its antidepressant activity.

Doxepin (Silenor)

Doxepin increases the concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake by the presynaptic neuronal membrane. It inhibits histamine and acetylcholine activity and has proven useful in treatment of various forms of depression associated with chronic pain.

Nortriptyline (Pamelor)

Nortriptyline has demonstrated effectiveness in the treatment of chronic pain.

Desipramine (Norpramin)

This is the original TCA used for depression. These agents have been suggested to act by inhibiting reuptake of noradrenaline at synapses in central descending pain modulating pathways located in the brainstem and spinal cord.

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Antidepressants, Other

Class Summary

The analgesic properties of certain agents in this class may improve symptoms associated with neuropathic pain.

Duloxetine (Cymbalta)

Duloxetine is indicated for diabetic peripheral neuropathic pain. It is a potent inhibitor of neuronal serotonin and norepinephrine reuptake.

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