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From: B. Harris)
Subject: Re: Tegretol&Itchiness
Date: 28 Apr 1998 03:31:01 GMT

In <6i2c2f$> (Emma Chase
VanCott) writes:

>Oh no!
>I am taking Tegretol for a neuralgia. It's making my itchy!
>(a) What else can i take?
>(b) What is the generic name for Baclofen?


    Obviously, stop taking it!  If you break out in a rash or have
trouble breathing, you should probably go to an emergency room.
Meanwhile, I don't think it would be inappropriate to take an
antihistamine if you have one that you've routinely used before.
Needless to say, consult your doctor first.

   Neurologists use many drugs for "neuralgia", and there aren't any
that work for everybody.  For some kinds of neuralgia, treatment is
related to cause of the disease, and there have been reports that
diabetic neuralgia responds to antioxidants and even to odd things like
inositol.  Neuralgias caused by mercury poisoning need to be treated
with appropriate chelating drugs, such as acetylpenicillamine, etc.

    For neuralgia without obvious cause, treatment is symptomatic.
Topical preparations using capsaisin, the active component of hot
peppers, are now available over the counter.  The gate theory of pain
also suggests, and studies show, that stimulation of other receptors in
the involved areas helps moderate pain (hot, cold, massage, electrical
stimulation, eg, TENS).  There are a number of preparations that
actually cause skin numbing by a direct anaesthetic effect, but of
course these can be unpleasant.

    As far as systemic medications go, antiseizure meds are popular for
neuralgia, and Tegretol, valproate, and (increasingly these days)
Neurontin/gabapentin probably top the list.  A heart drug called
Mexiletine has been used.  Low doses of amitriptyline (and
antidepressant) can help some.  Increasingly popular, due to very low
side effect incidence, has been nasal Calcitonin (Miacalcin), a drug
sold for osteoporosis that was accidentally found to help nerve pain as
well (it seems to work better at higher than recommended doses than
those used for osteoporosis, such as 2 or 3 sprays a day).  An old
anaesthetic called ketamine has been used topically and even in low
oral doses (50 mg once or twice a day), but must be obtained from
compounding pharmacies.  Compounding pharmacies are also great sources
of odd things like topical NSAID preparations, but your doctor needs to
be a little bit off beat to use such pharmacies to maximum advantage.

                                          Steve Harris, M.D.

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