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Table 7. Adjuvant Medications With Analgesic Activity

Class Drug Daily Dose Rangea Studies Conducted in: 
   Cancer Patients  Noncancer Patients  
Antidepressantsamitriptyline (Elavil)10–25 mg every day[208][Level of evidence: I][209][Level of evidence: I][210][Level of evidence: I]
desipramine (Norpramin)10–150 mg every day[211][Level of evidence: II][212][Level of evidence: II]
maprotiline (Ludiomil)25 mg bid–50 mg tid[213][Level of evidence: I]
duloxetine (Cymbalta)20 mg bid–30 mg bid[214][Level of evidence: I]
nortriptyline (Pamelor, Aventyl)10–100 mg every day[215][Level of evidence: I]
venlafaxine (Effexor)37.5–225 mg every day[216][Level of evidence: I][217][Level of evidence: II][218][Level of evidence: I]
Anticonvulsantscarbamazepine (Tegretol)100 mg tid–400 mg tid[219][Level of evidence: I]
valproate (Depacon)500 mg tid–1,000 mg tid[220][Level of evidence: I]
gabapentin (Neurontin)100 mg tid–1,000 mg tid[221][Level of evidence: I][222][Level of evidence: II][223][Level of evidence: II]
clonazepam (Klonopin)0.5 mg bid–4 mg bid[224][Level of evidence: II]
lamotrigine (Lamictal)25 mg bid–100 mg bid[225][Level of evidence: I]
pregabalin (Lyrica)150 mg divided into 2 or 3 doses; increase to 300 mg starting at day 3–7; if needed, increase to 600 mg 7 days later[226][Level of evidence: I]
Local anestheticsmexiletine (Mexitil)100 mg bid–300 mg tid[227][Level of evidence: I]
lidocaine patch (Lidoderm)5% patch contains 700 mg; one patch, 12 hours on, 12 hours off[228][Level of evidence: II]
Corticosteroidsdexamethasone (Decadron)See text
prednisoneSee text
BisphosphonatesclodronateSee text
pamidronate (Aredia)See text
zoledronic acid (Zometa)See text[229][Level of evidence: II]
NSAIDsRefer to Table 1 for more information.
Miscellaneousbaclofen (Lioresal)5 mg tid–20 mg tid[230][Level of evidence: I]
calcitonin (Calcimar)100–200 IU (subcutaneous or intranasal)
clonidine (Catapres)0.1 mg bid–0.3 mg bid[231]
methylphenidate (Ritalin)2.5 mg bid–20 mg bid[232][Level of evidence: I][233][Level of evidence: II]
ketamine (Ketalar)Refer to the NMDA Receptor Antagonists section of this summary for more information.

bid = twice a day; tid = 3 times a day.
aStarting doses should incorporate the lowest possible dose.


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