| Topical treatments |
| Capsaicin 0.075% cream | Four applications per day | Erythema, pain on application, rash | Avoid contact with eyes and mucous membranes; 8% patch available for application by trained clinicians every three months | $18 for 2-oz tube (over the counter) |
| Lidocaine 5% patch | Up to three patches per day | Blisters, local erythema, rash | Avoid in patients with allergy to amide local anesthetics | $219 for 90 generic patches |
| Systemic treatments |
| Amitriptyline | Initial dose of 10 to 25 mg orally at bedtime, then increase by 10 to 25 mg per week to target of 75 to 150 mg per day | Blurred vision, constipation, dry mouth, sedation, urinary retention, weight gain | Taper gradually when discontinuing therapy; use caution in older adults; avoid in patients with cardiac arrhythmias, glaucoma, seizure disorder, or suicide risk; avoid concomitant use of tramadol, selective serotonin reuptake inhibitors, and serotonin-norepinephrine reuptake inhibitors (risk of serotonin syndrome) | $4 for 30 75-mg generic tablets |
| Gabapentin (Neurontin) | 300 to 600 mg orally three times per day | Dizziness, peripheral edema, sedation, weight gain | Taper dose over seven days when discontinuing therapy; dosing adjustment required for patients with creatinine clearance ≤ 60 mL per minute per 1.73 m2 (1.00 mL per second per m2) | $13 for 90 300-mg generic capsules ($406 for brand name) |
| Pregabalin (Lyrica) | 150 to 300 mg orally per day in two or three divided doses | Dizziness, peripheral edema, sedation, weight gain | Taper dose over seven days when discontinuing therapy; dosing adjustment required for patients with creatinine clearance ≤ 60 mL per minute per 1.73 m2 | $395 for 60 75-mg brand name capsules (generic not available) |
