There can be variation in the licensing of
different medicines containing the same drug.
Spray
▶Zomig (Grunenthal Ltd)
Zolmitriptan 50 mg per 1 ml Zomig 5mg/0.1ml nasal spray 0.1ml
unit dose | 6 unit dose P £36.50 DT = £36.50
Orodispersible tablet
EXCIPIENTS: May contain Aspartame
▶Zolmitriptan (Non-proprietary)
Zolmitriptan 2.5 mg Zolmitriptan 2.5mg orodispersible tablets
sugar-free | 6 tablet P £20.35 DT = £11.50
Zolmitriptan 5 mg Zolmitriptan 5mg orodispersible tablets sugar-
free | 6 tablet P £20.35 DT = £13.41
▶Zomig Rapimelt (Grunenthal Ltd)
Zolmitriptan 2.5 mg Zomig Rapimelt 2.5mg orodispersible tablets
sugar-free | 6 tablet P £23.99 DT = £11.50
Zolmitriptan 5 mg Zomig Rapimelt 5mg orodispersible tablets sugar-
free | 6 tablet P £23.94 DT = £13.41
Tablet
▶Zolmitriptan (Non-proprietary)
Zolmitriptan 2.5 mg Zolmitriptan 2.5mg tablets | 6 tablet P
£23.94 DT = £6.20 | 12 tablet P £18.16–£28.00
Zolmitriptan 5 mg Zolmitriptan 5mg tablets | 6 tablet P £4.27
DT = £3.60 | 12 tablet P £7.20
▶Zomig (Grunenthal Ltd)
Zolmitriptan 2.5 mg Zomig 2.5mg tablets | 6 tablet P £23.94 DT
= £6.20
6.2 Neuropathic pain
Neuropathic pain
Overview and management
Neuropathic pain, which occurs as a result of damage to
neural tissue, includes phantom limb pain, compression
neuropathies, peripheral neuropathies (e.g. due to Diabetic
complications p. 726, chronic excessive alcohol intake, HIV
infection p. 677, chemotherapy, idiopathic neuropathy),
trauma, central pain (e.g. pain following stroke, spinal cord
injury, and syringomyelia), and postherpetic neuralgia
(peripheral nerve damage following acute herpes zoster
infection (shingles)). The pain may occur in an area of
sensory deficit and is sometimes accompanied by pain that is
evoked by a non-noxious stimulus (allodynia).
Trigeminal neuralgia is also caused by dysfunction of
neural tissue, but its management is distinct from other
forms of neuropathic pain.
Neuropathic pain is generally managed with a tricyclic
antidepressant or with certain antiepileptic drugs.
Amitriptyline hydrochloride p. 390 and pregabalin p. 341 are
effective treatments for neuropathic pain. Amitriptyline
hydrochloride and pregabalin can be used in combination if
the patient has an inadequate response to either drug at the
maximum tolerated dose.
Nortriptyline p. 395 [unlicensed indication] may be better
tolerated than amitriptyline hydrochloride.
Gabapentin p. 331 is also effective for the treatment of
neuropathic pain.
Neuropathic pain may respond to opioid analgesics.
There is evidence of efficacy for tramadol hydrochloride
p. 491, morphine p. 484, and oxycodone hydrochloride
p. 487; however, treatment with morphine or oxycodone
hydrochloride should be initiated only under specialist
supervision. Tramadol hydrochloride can be prescribed when
other treatments have been unsuccessful, while the patient
is waiting for assessment by a specialist.
Patients with localised pain who are unable to take oral
medicines may benefit from topical local anaesthetic
preparations, such as lidocaine hydrochloride medicated
plasters p. 1422, while awaiting specialist review.
Capsaicin below is licensed for neuropathic pain (but the
intense burning sensation during initial treatment may limit
use). Capsaicin 0.075% cream is licensed for the
symptomatic relief of postherpetic neuralgia. A self-adhesive
patch containing capsaicin 8% is licensed for the treatment
of peripheral neuropathic pain. It should be used under
specialist supervision.
A corticosteroid may help to relieve pressure in compression
neuropathy and thereby reduce pain.
Neuromodulation by spinal cord stimulation may be of
benefit in some patients. Many patients with chronic
neuropathic pain require multidisciplinary management,
including physiotherapy and psychological support.
Trigeminal neuralgia
Nervous system
Surgery may be the treatment of choice in many patients; a
neurological assessment will identify those who stand to
benefit. Carbamazepine p. 327 taken during the acute stages
of trigeminal neuralgia, reduces the frequency and severity
of attacks. It is very effective for the severe pain associated
with trigeminal neuralgia and (less commonly)
glossopharyngeal neuralgia. Blood counts and electrolytes
should be monitored when high doses are given. Small doses
should be used initially to reduce the incidence of side-
effects e.g. dizziness. Some cases respond to phenytoin
p. 339; the drug may be given by intravenous infusion
(possibly as fosphenytoin sodium p. 330) in a crisis
(specialist use only).
Chronic facial pain
Chronic oral and facial pain including persistent idiopathic
facial pain (also termed ‘atypical facial pain’) and
temporomandibular dysfunction (previously termed
temporomandibular joint pain dysfunction syndrome) may
call for prolonged use of analgesics or for other drugs.
Tricyclic antidepressants may be useful for facial pain
[unlicensed indication], but are not on the Dental
Practitioners’ List. Disorders of this type require specialist
referral and psychological support to accompany drug
treatment. Patients on long-term therapy need to be
monitored both for progress and for side-effects.
Other drugs used for Neuropathic pain Amantadine
hydrochloride, p. 437
ANALGESICS › PLANT ALKALOIDS
PDF pages 526, 527
