OPTION FOR PHN BY THE EUROPEAN FEDERATION OF NEUROLOGICAL SOCIETIES (EFNS)1

 

Classification of evidence for drug treatments in post-herpetic neuralgia (PHN)

 

Recommendations for first line Recommendations for second or third line Level A rating for Efficacy Level B rating for Efficacy Level A/B Rating for inefficacy or discrepant results
Gabapentin Capsaicin Capsaicin 8% patch** Capsaicin cream Benzydamide topical
Pregabalin Opioids Gabapentin Valproate* Dextromethorphan
TCA   Gabapentin ER**   Fluphenazine
5% Lidocaine plastersa)   5% Lidocaine plasters   Memantine
    Opioidsb)   Lorazepam
    Pregabalin   Mexiletine
    TCAc)   COX-2 inhibitor**
        Tramadol

 

Only drugs used at repeated dosages are shown here (with the exception of treatments with longlasting effects such as capsaicin patches). a) Lidocaine is recommended in elderly patients: b) morphine, oxycodone, methadone; c) Anmitriptyline, notripyline, desipramine, Imipramine. *found effective in sindle class II or III studies and generally nor recommended; **not yet available use. TCA = Tricyclic antidepressants; ER = Extended release. Adapted from Attal N et al. Eur J Neurol 2010.

 

References
1 1Attal et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J of Neurology 2010; 17:1113-23.