Radiation-Induced Brachial Plexopathy Medication

Updated: Apr 02, 2019
  • Author: Ryan O Stephenson, DO; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

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Anticonvulsants

Class Summary

Anticonvulsants are used to manage severe muscle spasms and provide pain relief in neuralgia.

Gabapentin (Neurontin, Gralise)

Gabapentin has anticonvulsant properties and antineuralgic effects; however, the exact mechanism of action is unknown. Gabapentin is structurally related to GABA but does not interact with GABA receptors.

Titration to effect can take place over several days (300 mg on day 1, 300 mg bid on day 2, and 300 mg tid on day 3).

Pregabalin (Lyrica)

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

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Tricyclic antidepressants

Class Summary

These agents have central and peripheral anticholinergic effects, as well as sedative effects, and block the active reuptake of norepinephrine and serotonin.

Amitriptyline

Amitriptyline is indicated as an analgesic for certain types of chronic and neuropathic pain.

Nortriptyline (Pamelor)

Nortriptyline has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, it increases synaptic concentration of these neurotransmitters in the CNS.

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Antidepressant, Selective Serotonin/norepinephrine Reuptake Inhibitor (ssnri)

Class Summary

These agents are a complex group of drugs that inhibit serotonin and norepinephrine reuptake. Some drugs in this class are weak inhibitors of dopamine reuptake with sedative effects.

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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