Version July 2025
* Patients with postherpetic neuralgia pain that is both neuralgic and neuropathic may require combination therapy directed toward the respective components of pain.
¶ "Contraindication or inadequate response" includes patients who are unable to tolerate the medication, those who report partial relief after a trial at an effective dose for at least one month, and those who otherwise prefer an alternative option.
Δ "Add or switch" selection depends on whether initial agent provided partial versus no relief, the risk of adverse effects due to medication interactions from adding another agent, and patient/clinician preferences. Patients starting on combination therapy may require dose adjustments or change to alternative agents to minimize the risk of adverse effects (eg, serotonin syndrome). Refer to UpToDate topic for additional details.
◊ For initial dose and titration schedules of alternative medications as well as adjunctive topical therapy (eg, lidocaine or capsaicin patches) and other nonpharmacologic options, refer to UpToDate content on postherpetic neuralgia.
§ Opioids are generally reserved for short-term use in patients with intractable pain during the initial titration of other medications. The risks and benefits of using opioid analgesic medications in this setting should be discussed with the patient before starting.
¥ Not useful for patients with trigeminal region or other cranial pain.
