2013 Volume 33 Issue 1 Pages 051-055
Recent guidelines for the treatment of neuropathic pain have listed tricyclic antidepressants as first line drugs. Among tricyclic antidepressants, amitriptyline and nortriptyline are established drugs for the treatment of neuropathic pain. However, tricyclic antidepressants do not seem to be used properly by Japanese physicians who treat patients with neuropathic pain. In patients using trycyclic antidepressants, the dose should be increased in patients who experience no pain relief or side-effects. The starting dose of amitriptyline/nortriptyline should be 10 or 20 mg/day. Thereafter, it should be gradually increased until pain is relieved or moderate to severe side-effects prevent further increase in the dose. Tricyclic antidepressants should be taken before bed time to avoid daytime sleepiness, even if the dose is large.
