| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Amitriptyline[1] | Tricyclic antidepressant | 10–25 mg PO at night start, titrate by 10–25 mg every 1–2 weeks to 75 mg/day max in pain | — | Effective for neuropathic pain and comorbid insomnia; anticholinergic effects (dry mouth, urinary retention, constipation, glaucoma); ECG before higher doses in cardiac comorbidity |
| Duloxetine[1] | Serotonin-norepinephrine reuptake inhibitor (SNRI) | 30 mg PO daily start, titrate to 60–120 mg daily | — | First-line especially with comorbid depression or anxiety; nausea on initiation; hepatic caution; avoid with MAOI and severe renal impairment |
| Gabapentin[1] | Gabapentinoid (α2δ ligand) | 300 mg PO night × 3 days, then 300 mg BD × 3 days, then 300 mg TDS; usual 900–3600 mg/day in three divided doses | — | First-line; lower cost than pregabalin; renal dose adjustment; sedation, dizziness, peripheral oedema common |
| Pregabalin[1] | Gabapentinoid | 75 mg PO BD start, titrate to 150–300 mg BD as tolerated | — | First-line; weight gain, sedation, peripheral oedema; renal dose adjustment; misuse potential — controlled in some jurisdictions |
| Topical capsaicin 8% patch[1] | TRPV1 agonist (topical) | Single 30-min application to affected area; can repeat every 90 days | — | Localised peripheral neuropathic pain (post-herpetic, diabetic localised); transient burning at application site; pre-treat with topical anaesthetic; specialist application |
| Topical lidocaine 5% patch[1] | Sodium channel blocker (topical) | Up to 3 patches applied to most painful area for up to 12 h/24 h | — | Localised neuropathic pain (post-herpetic neuralgia); minimal systemic absorption; safer in elderly with comorbidities |
| Tramadol (selected, short-term)[1] | Atypical opioid / SNRI | 50–100 mg PO every 4–6 h, max 400 mg/day | — | Reserve for severe refractory pain; risk of serotonin syndrome with serotonergic agents; dependence; avoid long-term and in elderly with falls risk |
Stepwise pharmacological and non-pharmacological management of neuropathic pain in adults including diabetic, post-herpetic, and post-surgical aetiologies.