Drug		Dosage	Side effects, contraindications, and comments
Antidepressants
Tricyclic antidepressants		—	Side effects: dry mouth, constipation, urinary retention, sedation, weight gain
			Contraindications: cardiac conduction abnormalities, recent cardiac events, narrow-angle glaucoma
	Amitriptyline (Elavil),* imipramine (Tofranil)*	10 to 25 mg at bedtime; increase by 10 to 25 mg per week up to 75 to 150 mg at bedtime or a therapeutic drug level.	Tertiary amines have greater anticholinergic side effects; therefore, these agents should not be used in elderly patients.
	Desipramine (Norpramin),* nortriptyline (Pamelor)*	25 mg in the morning or at bedtime; increase by 25 mg per week up to 150 mg per day or a therapeutic drug level.	Secondary amines have fewer anticholinergic side effects.
Selective serotonin reuptake inhibitors
	Fluoxetine (Prozac),* paroxetine (Paxil)*	10 to 20 mg per day; up to 80 mg per day for fibromyalgia.	Side effects: nausea, sedation, decreased libido, sexual dysfunction, headache, weight gain
			Efficacy in pain syndromes is relatively poor.
Novel antidepressants
	Bupropion (Wellbutrin)*	100 mg per day; increase by 100 mg per week up to 200 mg twice daily (400 mg per day).	Side effects: anxiety, insomnia or sedation, weight loss, seizures (at dosages above 450 mg per day)
	Venlafaxine (Effexor)*	37.5 mg per day; increase by 37.5 mg per week up to 300 mg per day.	Side effects: headache, nausea, sweating, sedation, hypertension, seizures
			Serotoninergic properties in dosages below 150 mg per day; mixed serotoninergic and noradrenergic properties in dosages above 150 mg per day
	Duloxetine (Cymbalta)*	20 to 60 mg per day taken once or twice daily in divided doses (for depression); 60 mg twice daily for fibromyalgia	Side effects: nausea, dry mouth, constipation, dizziness, insomnia
Antiepileptic drugs
First-generation agents
	Carbamazepine (Tegretol)	200 mg per day; increase by 200 mg per week up to 400 mg three times daily (1,200 mg per day).	Side effects: dizziness, diplopia, nausea
			Treatment can result in aplastic anemia.
	Phenytoin (Dilantin)*	100 mg at bedtime; increase weekly up to 500 mg at bedtime.	Side effects: dizziness, ataxia, slurred speech, confusion, nausea, rash
			Treatment can result in blood dyscrasias and hepatotoxicity.
Second-generation agents
	Gabapentin (Neurontin)	100 to 300 mg at bedtime; increase by 100 mg every 3 days up to 1,800 to 3,600 mg per day taken in divided doses three times daily.	Side effects: drowsiness, dizziness, fatigue, nausea, sedation, weight gain
	Pregabalin (Lyrica)	150 mg at bedtime for diabetic neuropathy; 300 mg twice daily for postherpetic neuralgia.	Side effects: drowsiness, dizziness, fatigue, nausea, sedation, weight gain
	Lamotrigine (Lamictal)*	50 mg per day; increase by 50 mg every 2 weeks up to 400 mg per day.	Side effects: dizziness, constipation, nausea; rarely, life-threatening rashes