This page from Great Ormond Street Hospital (GOSH) explains about medications used to treat neuropathic pain - pain caused by nerves sending wrong signals to and from the brain. At GOSH we mainly use amitriptyline, gabapentin and pregabalin, although other drugs are available. Pain occurs when receptors in our skin send a signal through the nerves to the spinal cord and brain. Damage to the receptors or the nerves themselves can cause erroneous signals. This leads to pain – how a person feels this pain varies, some report a dull ache but others describe it as a burning sensation or sharp pain. This pain is called neuropathic pain (neuro = nerves and pati = abnormality) and can occur after injury surgery as well as a symptom of other diseases/medical conditions or no obvious evidence.
the cause can be found.
The goal of treatment is to control symptoms without causing troublesome side effects. In addition to medication, other non-drug treatments are also available to help manage neuropathic pain. The medication prescribed to your child depends on the specific symptoms.
Amitriptyline
This is a tricyclic antidepressant medication, which alters the balance of chemicals in the brain called neurotransmitters, especially those called serotonin and norepinephrine. However, amitriptyline is used in low doses to manage neuropathic pain.
Amitriptyline is available as tablets in various strengths (10 mg, 25 mg and 50 mg) and as a liquid oral solution (25 mg/5 ml, i.e. each 5 ml of liquid contains 25 mg of the active ingredient).
How is it given?
Amitriptyline is usually started at a low dose and gradually increased over time until you reach the best dose to control symptoms without causing troublesome side effects. Most often it is taken once a day, in the evening.
Who should not take amitriptyline?
People with the following conditions should discuss the use of amitriptyline with their doctor.
nHypersensitivity to amitriptyline or any of its ingredients
- Pregnant, may be pregnant, trying to conceive or breastfeeding
- Existing heart or liver problems
- Existing mental health issues
What are the side effects?
If any of these side effects are severe or persist for a long time, tell your doctor.
- the heart flutters
- Vision problems
- Drowsiness - therefore a once-daily dose is best given in the evening
- Dry mouth
- Stomach pain – nausea and/or vomiting – tends to improve over time
- Cold
Amitriptyline and other medications
Some medicines can interact with amitriptyline and change how it works. Always check with your doctor or pharmacist before giving your child any other medicines, including medicines prescribed by your GP, medicines bought from a pharmacy (pharmacy), or herbal or complementary medicines. The following are known to react with amitriptyline:
- Opioid pain relievers such as morphine and tramadol – can cause extreme drowsiness
- anticoagulant medication
- Other antidepressant medications
- antiepileptic drugs
- Some antiviral drugs
Gabapentin and Pregabalin
Both gabapentin and pregabalin are anti-epileptic drugs that dampen electrical activity in the brain and therefore help reduce pain signals. The decision to use gabapentin or pregabalin will depend on your child's symptoms and how the frequency of doses can be balanced with school and social life. . This will be discussed with you and/or your child before treatment begins. Both gabapentinor and pregabalin are usually started at low doses and gradually increased over time until the best dose is reached to control symptoms without causing troublesome side effects. Occasionally, children and teenagers may become more emotional, show changes in behavior or feel very depressed while taking gabapentin or pregabalin. If this happens, talk to your doctor and, if necessary, the medication can be discontinued.
Gabapentin
Gabapentin is available as tablets in different strengths (600 mg and 800 mg) and capsules in different strengths (100 mg, 300 mg and 400 mg). If your child is unable to swallow the pills or capsules whole, the pills can be crushed or the capsule opened and the powder mixed with a strong tasting liquid or food. It is also available as a liquid oral solution (50 mg/ml, which means that each 1 ml of liquid contains 50 mg of the active ingredient).
How is it given?
Gabapentin is usually started at a low dose given in the evening and, if tolerated, increased to twice daily and then three times daily as directed.
Who should not take gabapentin?
People with the following conditions should discuss the use of gabapentin with their doctor.
- Hypersensitivity to gabapentin or one or more of its ingredients
- Pregnant, may be pregnant, trying to conceive or breastfeeding
- existing kidney problems
- Diabetes
- Existing mental health issues
What are the side effects?
If any of these side effects are severe or persist for a long time, tell your doctor.
- Lethargy, dizziness, and feeling shaky
- Change in appetite (eating more or less than usual)
- Stomach pain with nausea and vomiting
Gabapentin and other medications
Some medicines can interact with gabapentin and change how it works. Always contact your doctor or pharmacist before giving your child any other medicines,
including medicines prescribed by your GP, medicines purchased
from a pharmacy (pharmacy) or other herbal or complementary medicines. The following are known to react with gabapentin:
- Antacids to treat indigestion
- Opioid pain relievers such as morphine and tramadol – can cause extreme drowsiness
- antimalarial medicine
Pregabalin
Pregabalin (under the brand name Lyrica®) is available in capsules of various strengths – 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg and 300 mg. It is also available as a liquid oral solution (20 mg/ml, which means that each 1 ml of liquid contains 20 mg of the active ingredient).
How is it given?
Pregabalin is usually started at a low dose, given at night and, if tolerated, increased to
twice daily as directed.
Who should not take pregabalin?
People with the following conditions should discuss the use of pregabalin with their doctor.
- Hypersensitivity to pregabalin or one or more of its ingredients
- Pregnant, may be pregnant, trying to conceive or breastfeeding
- Existing problems with your kidneys, heart, or central nervous system
What are the side effects?
If any of these side effects are severe or persist for a long time, tell your doctor.
- Dizziness, headache and drowsiness
- bad stomach
- Dry mouth
- balance problems
Pregabalin and other medications
Some medications can interact with pregabalin and change how it works. Always check with your doctor or pharmacist before giving your child any other medicines, including medicines prescribed by your GP (general practitioner), medicines bought from a pharmacy (pharmacy), or other herbal or complementary medicines. The following are known to react with pregabalin:
- Lorazepam – a benzodiazepine used to treat anxiety
- Opioid pain relievers such as morphine and tramadol – can cause extreme drowsiness
- Medications to depress the central nervous system
Important information
- Always check the expiry date of the medicine before giving it to your child.
- Keep medicines in a safe place where children cannot reach them.
- If you forget to give your child a dose and it happens within hours of calculating the dose, give it as soon as you remember. Otherwise, do not administer this dose, but administer the next dose when necessary. Do not give a double dose.
- If your child vomits shortly after taking the dose, tell your doctor or local nurse, as your child may need to have another dose.
- If your doctor decides to stop treatment or if the medicine has passed its expiry date, you must return all unused medicines to the pharmacy. Do not flush down the toilet or throw it away.
Collected by:
The pharmacy and pain departments in collaboration with the Children and Families Information Group
Date of last notification:
december 2016
Reference:
2016F0442
Read this GOSH package insert together with the manufacturer's patient information leaflet (PIL). If you do not have a copy of the manufacturer's leaflet, talk to your pharmacist. Some products do not have a marketing authorization (license) as a medicine and therefore PIL does not exist.
For children in particular, there may be conflicts of information between the manufacturer's Patient Information Leaflet (PIL) and guidance from GOSH and other healthcare professionals. Some manufacturers may e.g. recommend in the package leaflet that the drug not be given to children under 12 years of age. In most cases, this is because the manufacturer wants to recruit adults into clinical trials, and therefore the initial marketing authorization (license) only covers adults and older children.
For new drugs, the manufacturer must then enroll children and neonates for trials (unless the drug is not for use in children and neonates) and subsequently amend the PIL with the approved information. Older drugs may have been used effectively for many years in children without problems, but the manufacturer was not obliged to collect data and change the license. This does not mean that it is not safe for children and young people to be prescribed such an off-licence/off-label medication. However, if you are concerned about any conflicting information, speak to your doctor, nurse or pharmacist.
useful documents
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useful numbers
GOSH change: 020 7405 9200
Information about pharmacy drugs: 020 7829 8608 from Monday to Friday from 9 am to 5 pm.