Which medications are used in the treatment of trigeminal neuralgia (TN)?

Updated: Oct 23, 2019
  • Author: Mityanand Ramnarine, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Answer

The goal of pharmacologic therapy is to reduce pain. Carbamazepine is regarded by most as the medical treatment of choice. Some advocate a trial of baclofen since it has fewer adverse effects. Oxcarbazepine may be better tolerated. The synergistic combination of carbamazepine and baclofen may provide relief from episodic pain though convincing clinical evidence is weak at best.

Other anticonvulsants including phenytoin, oxcarbazepine, clonazepam, lamotrigine, valproic acid, and gabapentin are reportedly beneficial in some patients; however, controlled trials have not been performed. The American Academy of Neurology published a practice parameter that concluded that carbamazepine is effective in controlling pain of patients with classic trigeminal neuralgia, and that oxcarbazepine is probably effective and may be better tolerated. [3] In another AAN guideline, baclofen, lamotrigine, and pimozide were rated as possibly effective. The practice parameter stated that there was insufficient evidence to support or refute efficacy of clonazepam, gabapentin, phenytoin, tizanidine, topical capsaicin, or valproate for pain control in patients with classic trigeminal neuralgia. [8] The writing group was unable to find sufficient evidence to support or refute the use of intravenous medications in acute exacerbations of trigeminal neuralgia.

A small randomized placebo-controlled trial using intraoral 8% lidocaine applied by the patient to the painful oral area suggested some benefit in patients with trigeminal neuralgia and severe intraoral pain. [14] More study is needed.


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