Neuralgias trigeminal

Thyrotoxicosis Pheochromocytoma Myotonic dystrophy Trigeminal neuralgia... 

GlaserMA. 1931. Treatment of trigeminal neuralgia with trichloroethylene. JAMA 96 916-920. 

Trigeminal neuralgia A disorder of the fifth cranial (trigeminal) nerve characterized by excruciating paroxysms of pain in the face. 

Trigeminal neuralgia 100 mg bid titrate to 400 mg bid. Macrolide antibiotics elevate carbamazepine level. 

Largactil is a proprietary preparation of chlorpromazine, an aliphatic antipsychotic with marked sedation and moderate antimuscarinic and extrapyramidal side-effects. Serenace is a proprietary preparation of haloperidol, a butyrophenone antipsychotic with marked extrapyramidal side-effects, moderate sedation but not very likely to cause hypotension. Tegretol is a proprietary preparation of carbamazepine, an anti-epileptic drug indicated in partial and secondary generalised tonic-clonic seizures, primary generalised tonic-clonic seizures, trigeminal neuralgia and in the prophylaxis of bipolar disorder unresponsive to lithium. 

Carbamazepine is an anti-epileptic, which may also be used in the treatment of trigeminal neuralgia. Monitoring of carbamazepine plasma concentrations is required if high doses are administered as carbamazepine tends to be an autoinducer, meaning that the half-life is shortened following repeated administration of the drug. 

Trigeminal neuralgia pain and spasms along the trigeminal facial nerve... 

Carbamazepine is also used to treat trigeminal neuralgia and neuropathic pain. 

Baclofen, labeled as a skeletal muscle relaxant binds to GABA receptors and depresses excitation. It is also useful in the treatment of paroxysms of trigeminal neuralgia. Baclofen is effective in patients with carbamazepine-resistant pain and has been used successfully to relieve attacks in patients previously unresponsive to carbamazepine or phenytoin. 

Antiepileptic drugs as a class have been widely smdied and prescribed for the relief of acute and chronic pain. In general, there is the greatest support for the efficacy of antiepileptics in the treatment of trigeminal neuralgia and diabetic neuropathy and for migraine prophylaxis. 

Carbamazepine is an effective agent for the treatment of partial seizures and generalized tonic-clonic seizures its use is contraindicated in absence epilepsy. Carbamazepine is also useful in the treatment of trigeminal neuralgia and is an effective agent for the treatment of bipolar disorders (see Chapter 33). 

Trigeminal neuralgia, diabetic neuropathy PO Initially 100 mg 1-2 times a day. May increase by 100 mg/day at weekly intervals. Usual dose 400-1000 mg/day. 

Seizure frequency and elecf roencephalogram changes in paf ienf s with seizure disorder a reduction or elimination of pain in patients with trigeminal neuralgia therapeutic serum levels not adequately established use estimates of therapeutic serum concentrations of fhe acfive metabolite (MHD) in the 50-110 pmol range serum electrolytes (especially sodium), LFTs, blood counts, serum lipids... 

Phenytoin Adjunct in treatment of tricyclic antidepressant toxicity, muscle relaxant in treatment of muscle hyperirritability, treatment of digoxin-induced arrhythmias and trigeminal neuralgia... 

Unlabeled Uses Low back pain, spasticity associated with multiple sclerosis or spinal cord injury, tension headaches, trigeminal neuralgia... 

It is structurally and chemically related to tricyclic antidepressant drug imipramine and pharmacologically it is similar to diphenyl hydantoin sodium. It is effective in grandmal and psychomotor epilepsy and also in the treatment of trigeminal neuralgia (a condition characterized by paroxysms of intense pain of stabbing nature within the area of distribution of trigeminal nerve without sensory loss). 

Closely related to imipramine and other antidepressants, carbamazepine is a tricyclic compound effective in treatment of bipolar depression. It was initially marketed for the treatment of trigeminal neuralgia but has proved useful for epilepsy as well. 

Considerable concern exists regarding the occurrence of idiosyncratic blood dyscrasias with carbamazepine, including fatal cases of aplastic anemia and agranulocytosis. Most of these have been in elderly patients with trigeminal neuralgia, and most have occurred within the first 4 months of treatment. The mild and persistent leukopenia seen in some patients is not necessarily an indication to stop treatment but requires careful monitoring. The most common idiosyncratic reaction is an erythematous skin rash other responses such as hepatic dysfunction are unusual. 

Carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia... 

In 1962, Blom was the first to report the analgesic properties of carbamazepine in neuropathic pain conditions. In clinical studies in patients suffering from trigeminal neuralgia, oral doses of up to 2400 mg/day for 5 to 14 days produced moderate to excellent results (Campbell et al., 1966 Killian and Fromm, 1968 Nicol,... 

In fact, carbamazepine is recommended as the drug of first choice in the treatment of trigeminal neuralgia. Results from clinical trials have been positive in the treatment of painful diabetic neuropathy (Rull et al., 1969 Wilton, 1974 Gomez-Perez et al., 1996). After 4 weeks treatment with carbamazepine, central pain after stroke was improved only in five out of 14 patients (Leijon and Boivie, 1989). Carbamazepine was found to be effective for migraine prophylaxis (Rompel and Bauermeister,... 

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