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Post-herpetic neuralgia - Management
How should I treat post-herpetic neuralgia?
- Initiate treatment with paracetamol, either alone or in combination with codeine.
- If this is not effective, or the person presents with severe pain, consider offering amitriptyline (off-label use) or pregabalin (or gabapentin if there is a local decision to prefer gabapentin over pregabalin) for initial treatment.
- The choice of drug depends on the relative contraindications, possible drug interactions, and risk of adverse effects for each person.
- Titrate the dosage according to response and tolerability.
- For further information, on contraindications, cautions, managing adverse effects, and second-line options if amitriptyline or pregabalin are not effective, see the CKS topic on Neuropathic pain - drug treatment.
- Nonsteroidal anti-inflammatory drugs are not recommended because there is no evidence on their efficacy in postherpetic neuralgia.
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