The Use of Medication on Trigeminal Neuralgia.
There are different types of medication that is used to treat Trigeminal Neuralgia. The medications fall into two different categories; these being anticonvulsants and skeletal muscle relaxants. Often times during the treatment if one drug proves to be ineffective then alternately other drugs may be tried on their own or with a combination of others.
For most people who suffer from Trigeminal Neuralgia, medication is initially effective for most patients. On the flip side, about half of the people who suffer from the condition often become dissatisfied with the results the medication provides. This is mainly due to the drugs not providing complete control of the pain or some drug-related side effects are too much to handle. In cases like this, surgical treatment of Trigeminal Neuralgia is then considered.
Types of Trigeminal Neuralgia Medication
Carbamazepine (Tegretol, Carbatrol)
Carbamazepine is a very popular anticonvulsant drug. This medication is very common for the treatment of trigeminal neuralgia. When a patient who suffers from the condition takes carbamazepine then they will experience some amount of reduction in the pain they feel. The downside to this is that the effectiveness of the drug decreases over time. Initially the starting daily dose of carbamazepine is low, around one to two pills a day. Once there seems to be some amount of success, the dosage is increased until the pain is completely alleviated or side effects occur.
Pain relief can often be achieved by taking carbamazepine at low doses. Typically success has been seen with dosages ranging from 600 to 1600 mg. This is often divided into three or four doses a day. Often time’s patients are given higher dosages if they have severe bouts of pain. If relief from the pain of trigeminal neuralgia is achieved then the dosage that worked will be used for up to two weeks. After the two weeks doctors will reduce it to find a minimal dosage that provides pain relief.
There are side effects that occur when individuals take carbamazepine. These often are confusion, nausea, dizziness and sleepiness, mental confusion, , anorexia, nystagmus (rapid movements of the eye), ataxia (decreased coordination), diplopia (double vision), nausea and drowsiness. If patients suffer severe episodes of side effects the dosage of carbamazepine may be decreased for 1 to 3 days. Once there is some reduction then the doctors will try and increase the daily dose again.
Using the carbamazepine drug to treat trigeminal neuralgia has some rare but serious reactions that can occur and this is not related to the dosage. Some patients may develop an allergic skin rash. Other reactions include liver toxicity, water intoxication (retention of water), congestive heart failure, disorders of taste, hyponatremia (low sodium in the blood), visual hallucinations or sexual dysfunction. Around 2-6% of people who take carbamazepine usually develop disorders of the blood such as aplastic anemia (when the bone marrow stops producing blood cells), granulocytosis (drop in the number of white blood cells) or leucopenia.
As a result that these complications may occur, blood tests may be done before carbamazepine is started, and repeated intermittently. The prescribed use of carbamazepine should be stopped if the white blood cell counts become abnormally low. A doctor should examine these changes and from here blood tests should be conducted, especially if the patient experiences easy bruising, sore throat, fever, petechiae (tiny red spots on the skin) or stomatitis (painful infection of the mouth).
Baclofen is known as an effective muscle relaxant. The effectiveness of the drug may be increased when it is used with a combination of the drugs phenytoin or carbamazepine. The dosage of Baclofen is usually 50-60 mg. This is given to patients between 2-3 times a day. Baclophen does not last a long time, as a result people who suffer from Trigeminal Neuralgia may need to take it every 3-4 hours.
The side effects are known to become more severe once the dosage has been increased. To reduce the side effects patients are usually started out on low doses. Aroudn 1/10th of patients who take this medication cannot tolerate it.
General side effects with this medication for Trigeminal Neuralgia are drowsiness, confusion and nausea, leg weakness. Rare complications such as patients being in a state of confusion can occur. This can be corrected quickly when the therapy is stopped. Baclofen should not be stopped suddenly after prolonged use, this is because seizures or hallucinations may occur. If these withdrawal symptoms do occur, the previous dose of baclophen is usually re-instituted and then gradually reduced.
Gabapentin is an anti-epileptic drug that has success in the treatment of Trigeminal Neuralgia. This drug is known to be as effective as carbamazepine, but it has fewer side effects associated with its use. Patients are usually given around 300mg three times a day and this is increased to a maximal dose.
The side effects associated with the use of Gabapentin are fatigue, somnolence (sleepiness), nystagmus (rapid movements of the eye) and ataxia (decreased coordination). It should be noted that the stoppage in use of these drugs should be monitored. If stopped immediately, there is the possibility of severe withdrawal symptoms occurring.
Oxcarbazepine is another anticonvulsant medication that has similarities to carbamazepine. The dose usually begins at 300 mg twice a day and increased gradually to achieve pain control. The dosage for the day is 2400-3000 mg per day.
Side effects are less severe and less frequently experienced compared to taking carbamazepine. Typically patients will experience fatigue, vomiting, nausea and dizziness. Other less frequent symptoms are double vision, changes in electrolytes in the blood, respiratory infections and rashes.
Patients who have had an allergic reaction to carbemazepine should not try Trilepatal. As with other anti-seizure medications, increasing and decreasing the dose should be gradual.
Phenytoin (Dilantin, Phenytek)
Phenytoin is an anticonvulsant medication and it was one of the first medications used to treat the condition trigeminal neuralgia. Phenytoin is known to reduce the pain in over half of the patients who take the drug. Generally doses of 300-500 mg are given, 3 times per day. There is also the option of having Phenytoin may also be administered intravenously to treat severe exacerbations of Trigeminal Neuralgia. The maximum dosage given to patients is often determined by the severity of side effects that they experience in taking the drug.
Side effects include gum enlargement, dizziness, drowsiness, dysarthria (speech difficulty), nystagmus (rapid movements of the eye), ataxia (decreased coordination), ophthalmoplegia (paralysis of eye movements) mental confusion. Other effects of the medication may include hypertrichosis (excessive hair growth). The use of Phenytoin has sometimes resulted in serious complications, but these are rare. This may include blood disorders, skin rashes and liver damage.
General Information on Trigeminal Neuralgia
Eventually some people who suffer from Trigeminal Neuralgia may stop responding to medications. Others may experience a wide variety of side effects. For those groups of people the best option would be surgery or a combination of surgery and medications may be an option.
Other anticonvulsants including phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin are reportedly beneficial in some patients; however, controlled trials have not been performed. A small study reported topiramate beneficial in refractory cases.