Adjuvant drugs Adjuvants are the pharmacological substances, or immunological agents, which alter the effect of a drug. Antidepressants, anticonvulsants, local anesthetics, and corticosteroids are the most common adjuvants used in pain management. When
adjuvants are combined with opioids they provide the maximum effect. The frequently used adjuvant drugs are mentioned in Table 3 [20][21] .
Table 3: Common Adjuvant Drugs Drug Indications
Contraindications
Side effects
Dose
Tricyclic Antidepressants
Amitriptyline (Elavil) • Depression. • Neuropathic pain. • Insomnia.
• People with heart disease. • Emotionally unstable people.
• Constipation. • Dry mouth. • Blurred vision.
• Cognitive changes. • Tachycardia. • Urinary retention.
10 mg to 25 mg daily.
Nortriptyline (Pamelor, Aventyl)
• Major
• People who
• Dry mouth. • Sedation. • Constipation. • Increased appetite.
• Mild blurred vision. • Tinnitus. • Euphoria. • Mania.
10 mg to 100 mg daily.
depression. • Childhood bedwetting. • Chronic fatigue syndrome. • Chronic pain. • Neuralgia. • Depression. • Neuropathic pain. • Attention deficit hyperactivity disorder. • Substance- related disorder.
undergo acute recovery stage after myocardial infarction.
Desipramine (Norpramin)
• People who
• Nausea. • Weakness/tiredness. • Dry mouth. • Skin more sensitive to sunlight than usual. • Changes in appetite or weight. • Constipation.
• Difficulty urinating. • Frequent urination. • Blurred vision. • Changes in sex drive or ability. • Excessive sweating.
10 mg to 150 mg daily.
undergo acute recovery stage after myocardial infarction.
Anticonvulsants
Drug
Indications
Contraindications • Pregnant mothers. • Patients with a history of: • Previous bone marrow depression. • Hypersensitivity to the drug. • Known sensitivity to any of the tricyclic compounds.
Side effects
Dose
Carbamazepine (Tegretol)
• Epileptic seizures. • Trigeminal neuralgia. • Mania. • Bipolar disease. • Depression. • Posttraumatic stress disorder. • Certain pain syndromes. • Epileptic seizures. • Anorexia nervosa. • Panic attack. • Anxiety disorder. • Posttraumatic stress disorder. • Migraine. • Bipolar disorder.
• Drowsiness & dizziness. • Unsteadiness. • Nausea & vomiting. • Headache. • Anxiety.
• Memory problems. • Diarrhea. • Constipation.
100 mg to 400 mg 3 times a day.
• Heartburn. • Dry mouth. • Back pain.
Sodium Valproate (Depacon)
• Pregnancy.
• Tiredness. • Tremors.
• Nausea & vomiting. • Sedation.
500 mg to 1,000 mg 3 times a day.
Local Anesthetics
Drug
Indications
Contraindications • Hypersensitivity to local anesthetics.
Side effects
Dose
Lidocaine patch (Lidoderm)
• Pain of post- herpetic neuralgia.
• Bruising. • Burning sensation. • Depigmentation. • Dermatitis. • Discoloration. • Edema.
• Erythema. • Exfoliation. • Irritation. • Papules. • Petechia. • Pruritus. • Vesicles.
5% patch contains 700 mg: One patch, 12 hours on, 12 hours off.
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