Pain Management: Neuropathic Pain

Introduction
Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury. With
neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These
damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury
includes a change in nerve function both at the site of injury and areas around the injury.
One example of neuropathic pain is called phantom limb syndrome. This occurs when an arm or a leg
has been removed because of illness or injury, but the brain still gets pain messages from the nerves
that originally carried impulses from the missing limb. These nerves now misfire and cause pain.

What causes neuropathic pain?

Neuropathic pain often seems to have no obvious cause; but, some common causes of neuropathic pain
include:

Alcoholism
Amputation
Back, leg, and hip problems
Chemotherapy
Diabetes
Facial nerve problems
HIV infection or AIDS
Multiple sclerosis
Shingles
Spine surgery

What are the symptoms of neuropathic pain?

Symptoms may include:
Shooting and burning pain
Tingling and numbness

How is neuropathic pain diagnosed?

A doctor will conduct an interview and physical exam. He or she may ask questions about how you
would describe your pain, when the pain occurs, or whether anything specific triggers the pain.

How is neuropathic pain treated?

Some neuropathic pain studies suggest the use of non-steroidal anti-inflammatory drugs, such as Aleve
or Motrin, may ease pain. Some people may require a stronger painkiller, such as those containing
morphine. Anticonvulsant and antidepressant drugs seem to work in some cases.

If another condition, such as diabetes, is involved, better management of that disorder may alleviate the
pain.
In cases that are difficult to treat, a pain specialist may use invasive or implantable device therapies to
effectively manage the pain. Electrical stimulation of the nerves involved in neuropathic pain
generation may significantly control the pain symptoms.
Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally
may get worse instead of better over time. For some people, it can lead to serious disability.

Patient Discussions - Viewers share their comments

Neuropathic Pain
The MedicineNet physician editors ask:
What was the cause of your neuropathic pain?
I have had 3 back operations. The 1st was due to a bulging disc and I had to have it removed. I take
120mg of morphine per day and 40ml of oramorph medicine. I`ve been diagnosed as having Chronic
Neuropathic pain and the specialists have said there is no more they can do for me. I`m unable to walk
and spend most of my days in bed unable to move due to tremendous pain. Is there any advice that
anyone can give me as I am very depressed and don't know what to do.
Related Reading: Neuropathic pain
Comment from: VikiMason, 55-64 Female (Patient) Published: April 12
I'm two years out from chemotherapy for breast cancer. I'm enjoying a fine remission, however I've
been told my sundry symptoms indicate neuropathic pain. My fingers and toes buzz and tingle. I also
frequently have what behaves like gouty arthritis in my feet and hands. My uric acid levels are
generally good when this happens. I get more and more confused about the nature of this condition. I'm
also pretty discouraged.
Related Reading: chemotherapy | breast cancer | arthritis
Comment from: Fate, 35-44 Female (Patient) Published: April 08
I was caught in a crossfire and got shot 7 times, 2 to the torso, 2 to the left arm and 3 to the right thigh.
I was also injured in the grenade blast, multiple fragments to my entire body. I was inside a car then
that crashed on a 30 feet cement wall causing concussion and abrasions. I've been diagnosed with
Neuropathic & Nociceptive Chronic Pain Syndrome. This was 23+ years ago.
Related Reading: concussion | Chronic Pain
Comment from: Tewey, 45-54 Male (Patient) Published: February 17
Diabetes (Type 1) was the cause of my neuropathic pain. For a few years the pain in my calves (left
more than right) was more of an irritation than a disability, but about three years ago, after a serious
hypo which I over-treated (too much orange juice) I found I could not walk at all. For almost a year I

was unable to walk more than a few yards without crippling pain, but after a few months I was able to
ride a bicycle, and now I can walk a couple of miles (though not very fast) and I can ride my bicycle
for an hour or more. The pain is still there, and it is worse when I walk, but it is never as severe as three
years ago. I think the daily yoga is helping.

How Nerve Pain Feels

People with nerve pain feel it different ways. For some, it's a stabbing pain in the middle of the night.
For others, it's a chronic tingling or burning they feel all day.
Uncontrolled nerve pain can be hard to bear. But with treatment, it can often be controlled.

Understanding Nerve Pain

Pain is supposed to be a warning. When your hand gets too close to a stove, the nerves send a pain
signal to the brain -- and you pull back before you burn yourself. But if you have nerve pain, that
system isn't working. Damaged nerves may send false signals -- and you feel real pain without another
cause. Or damaged nerves may stop you from feeling pain when you have an injury.

Nerve Pain Triggers

Some find that certain body positions or activities -- like standing in line or walking -- may become
painful. Nerve damage may also make your body overly sensitive. Even a gentle breeze on your face
may become excruciating.

Loss of Feeling
Nerve damage may cause loss of sensation, making it harder to do things with your hands. Knitting,
typing, and tying your shoes may become difficult. Many people with nerve damage say that their
sense of touch feels dulled, as if they are always wearing gloves.

Nerve Pain and Sleep

Nerve pain is often worst at night. The touch of sheets or the pressure of lying down may be terribly
uncomfortable. If you can't sleep because of your nerve pain, make sure to mention it to your doctor.
Changing some habits or taking medicine could help

Losing Balance
In addition to dulling your sense of touch, nerve damage may decrease muscle strength. These two
effects may make it harder to keep your balance -- and that could lead to falls. Assistive devices -- like
braces, canes, or walkers -- may help.

Unseen Injuries
Nerve damage doesn't just cause pain. It may also cause numbness that may prevent you from feeling
pain when it matters. People with nerve damage sometimes hurt themselves without realizing it. Your
doctor may recommend that you check yourself for injuries regularly -- especially your feet.

Nerve Pain Progression

Left untreated, nerve damage may worsen over time. It usually starts in the nerves farthest from the
brain and spinal cord -- like those in the feet and hands. Then it may move up into the legs and arms.
However, if you get control of your nerve pain promptly, you may be able to stop the damage -- and
even reverse it.

OTC Treatments for Nerve Pain

Over-the-counter painkillers may be the first treatment your doctor recommends. These may include
nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen -- or analgesics, such as
acetaminophen. Other options include painkilling creams, ointments, oils, gels, or sprays that are used
on the skin.

Nerve Pain: Prescription Treatments

There are many prescription medicines that may help with nerve pain. Some are powerful painkillers.
Other drug types might help too. Studies have found that some medicines originally used for depression

and epilepsy may also help relieve nerve pain.

Natural Treatments for Nerve Pain

Complementary or alternative treatments may help. For instance, studies have found that acupuncture
may ease nerve pain. In some cases, nerve pain is caused or aggravated by a deficiency of vitamin B12.
Taking supplements -- under your doctor's care -- could help.

Taking Control of Your Health

In addition to working with your doctor to find treatment that works, you can take other steps to fight
chronic pain. Getting regular exercise, keeping a healthy weight, and improving your diet may help.

GENERIC NAME: naproxen

BRAND NAME: Anaprox, Naprelan, Naprosyn, Aleve
DRUG CLASS AND MECHANISM: Naproxen belongs to a class of drugs called nonsteroidal
antiinflammatory drugs (NSAIDs). Other members of this class include ibuprofen (Motrin),
indomethacin (Indocin), nabumetone (Relafen) and several others. These drugs are used for the
management of mild to moderate pain, fever, and inflammation. They work by reducing the levels of
prostaglandins, chemicals that are responsible for pain, fever, and inflammation. Naproxen blocks the
enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of
prostaglandins. As a consequence, inflammation, pain and fever are reduced. Naproxen was approved
by the FDA in December 1991.
PRESCRIPTION: Yes; (Aleve, no)

GENERIC AVAILABLE: Yes

PREPARATIONS:

Anaprox (tablets): 275 and 550 mg;

Naprosyn (tablets): 250, 375, and 500 mg;
Naprosyn suspension: 125 mg/5ml;
EC-Naprosyn: 375 mg,
Aleve: 220 mg;
Naprelan (controlled-release tablets): 375 and 500mg.

STORAGE: Naproxen should be stored at room temperature: 15-30 C (59-86 F).

PRESCRIBED FOR: Naproxen is used for the treatment of mild to moderate pain, inflammation, and
fever.
DOSING: The usual adult dose is 250-500 mg twice daily using regular naproxen tablets. The usual
dose for Naprelan controlled release tablets is 750 to 1000 mg given once daily. For EC-Naprosyn, the
usual dose is 375-500 mg twice daily. Naproxen should be given with food to reduce upset stomach.
DRUG INTERACTIONS: Naproxen is associated with several suspected or probable interactions that
affect the action of other drugs. The following examples are the most common suspected interactions.
Naproxen may increase the blood levels of lithium (Eskalith) by reducing the excretion of lithium by
the kidneys. Increased levels of lithium may lead to lithium toxicity.
Naproxen may reduce the blood pressure lowering effects of blood pressure medications. This may
occur because prostaglandins play a role in the regulation of blood pressure.
When naproxen is used in combination with methotrexate or aminoglycosides (for example,
gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because
the eliminationfrom the body is reduced. This may lead to more methotrexate or aminoglycosiderelated side effects.
Individuals taking oral blood thinners or anticoagulants [for example, warfarin, (Coumadin)] should
avoid naproxen because naproxen also thins the blood, and excessive blood thinning may lead to
bleeding.
PREGNANCY: There are no adequate studies of naproxen in pregnant women. Therefore, naproxen is
not recommended during pregnancy.
NURSING MOTHERS: A small amount of naproxen is excreted in breast milk. Because the
concentration in breast milk is low, breastfeeding while taking naproxen probably is not harmful to the
infant.
SIDE EFFECTS: The most common side effects from naproxen are rash, ringing in the ears,
headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, heartburn, fluid
retention and shortness of breath.
NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Naproxen
also may cause stomach and intestinal bleeding and ulcers. Sometimes, stomach ulceration and
intestinal bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness
upon standing may be the only signs of the bleeding.
People who are allergic to other NSAIDs should not use naproxen. NSAIDs reduce the flow of blood to

the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients with
preexisting impairment of kidney function or congestive heart failure, and use of NSAIDs in these
patients should be done cautiously. Individuals with asthma are more likely to experience allergic
reactions to naproxen and other NSAIDs. Fluid retention, blood clots, heart attacks, hypertension, and
heart failure have also been associated with the use of NSAIDs.
WARNING: This drug may infrequently cause serious (rarely fatal) bleeding from the stomach or
intestines. This side effect can occur without warning at any time during treatment with naproxen. The
elderly are at increased risk for serious stomach/intestinal bleeding.
Drugs related to naproxen have rarely caused blood clots to form, resulting in serious (possibly fatal)
heart attacks and strokes. This medication might also rarely cause similar problems. The risk of these
serious side effects may increase if you have heart disease and with longer use of this medication. Talk
to your doctor or pharmacist about the benefits and risks of treatment, as well as other possible
medication choices.
Stop taking naproxen and seek immediate medical attention if you notice any of the following rare but
very serious side effects: black stools, persistent stomach/abdominal pain, vomit that looks like coffee
grounds, chest pain, shortness of breath, weakness on one side of the body, sudden vision changes,
slurred speech.
This medication should not be used right before or after heart bypass surgery.
USES: Naproxen is used to relieve pain and swelling (inflammation) from various conditions. It is used
to treat headaches, muscle aches, backaches, tendonitis, dental pain, and menstrual cramps. It also
reduces pain, swelling, and joint stiffness caused by arthritis, bursitis, and gout attacks. Reducing these
symptoms helps you do more of your normal daily activities. This medication is known as a
nonsteroidal anti-inflammatory drug (NSAID).

naproxen - oral, Anaprox, Naprosyn (cont.)

HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using
naproxen and each time you get a refill. If you have any questions regarding the information, consult
your doctor or pharmacist.Take this medication by mouth with a full glass of water (8 ounces or 240
milliliters) unless your doctor directs you otherwise. Do not lie down for at least 30 minutes after
taking this drug. To prevent stomach upset, take this medication with food, milk, or an antacid.Dosage
is based on your medical condition and response to therapy. Do not take more than 1,500 milligrams of
naproxen (equal to 1,650 milligrams of naproxen sodium) per day. To minimize side effect risks (e.g.,
stomach bleeding), use this medication at the lowest effective dose for the shortest possible length of
time. Do not increase your dose or take it more often than prescribed. For ongoing conditions such as
arthritis, continue taking it as directed by your doctor. Discuss the risks and benefits with your doctor
or pharmacist.In certain conditions (e.g., arthritis), it may take up to 2 weeks of regular use before the
full benefits of this drug take effect.If you are taking this drug on an "as needed" basis (not on a regular
schedule), remember that pain medications work best if they are used as the first signs of pain occur. If
you wait until the pain has significantly worsened, the medicine may not work as well.If you use this
medication for migraine headache, and the pain is not relieved or worsens after the first dose, tell your
doctor immediately.Inform your doctor if your condition worsens.
SIDE EFFECTS: See also Warning section.Upset stomach, nausea, heartburn, diarrhea, constipation,

headache, tiredness, drowsiness, and dizziness may occur. If any of these effects persist or worsen,
notify your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication
because he or she has judged that the benefit to you is greater than the risk of side effects. Many people
using this medication do not have serious side effects.Tell your doctor immediately if any of these
unlikely but serious side effects occur: stomach pain, difficult/painful swallowing, swelling of the
hands/feet, sudden/unexplained weight gain, vision changes, hearing changes (e.g., ringing in the ears),
mental/mood changes (e.g., depression), fast/pounding heartbeat, persistent/severe headache,
fainting.Tell your doctor immediately if any of these rare but very serious side effects occur: change in
the amount of urine, easy bruising/bleeding, signs of infection (e.g., fever, persistent sore throat),
unexplained stiff neck.This drug may rarely cause serious (possibly fatal) liver disease. If you notice
any of the following rare but very serious side effects, stop taking naproxen and tell your doctor
immediately: yellowing eyes/skin, dark urine, unusual/extreme tiredness, severe stomach/abdominal
pain, persistent nausea/vomiting.A very serious allergic reaction to this drug is unlikely, but seek
immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash,
itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a
complete list of possible side effects. If you notice other effects not listed above, contact your doctor or
pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side
effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for medical advice about side effects.
You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking naproxen, tell your doctor or pharmacist if you are allergic to it; or to
aspirin or other NSAIDs (e.g., ibuprofen, celecoxib); or if you have any other allergies.This medication
should not be used if you have certain medical conditions. Before using this medicine, consult your
doctor or pharmacist if you have: aspirin-sensitive asthma (a history of worsening breathing with
runny/stuffy nose after taking aspirin or other NSAIDs), severe kidney disease, recent heart bypass
surgery (CABG).Before using this medication, tell your doctor or pharmacist your medical history,
especially of: kidney disease, liver disease, poorly controlled diabetes, stomach/intestine/esophagus
problems (e.g., bleeding, ulcers), heart disease (e.g., congestive heart failure, history of heart attack),
high blood pressure, stroke, swelling (edema, fluid retention), a severe loss of body water
(dehydration), blood disorders (e.g., anemia), bleeding or clotting problems, asthma, growths in the
nose (nasal polyps).Some naproxen products contain salt (sodium). Tell your doctor if you are on a saltrestricted diet.Before having surgery, tell your doctor or dentist that you are using this medication.This
drug may make you dizzy or drowsy. Do not drive, use machinery, or do any activity that requires
alertness until you are sure you can perform such activities safely.This medicine may cause stomach
bleeding. Daily use of alcohol and tobacco may increase your risk for stomach bleeding, especially
when combined with this medicine. Limit alcohol and stop smoking. Consult your doctor or pharmacist
for more information.This medication may make you more sensitive to the sun. Avoid prolonged sun
exposure, tanning booths, and sunlamps. Use a sunscreen and wear protective clothing when
outdoors.The elderly may be more sensitive to the side effects of this drug, especially
stomach/intestinal bleeding and kidney effects.This medication should be used only when clearly
needed during the first 6 months of pregnancy. It is not recommended for use during the last 3 months
of pregnancy due to possible harm to the unborn baby and interference with normal labor/delivery.
Discuss the risks and benefits with your doctor.This drug passes into breast milk. While there have
been no reports of harm to nursing infants, consult your doctor before breast-feeding.
DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be
aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change
the dosage of any medicine before checking with them first.This drug should not be used with the

following medications because very serious interactions may occur: high doses of aspirin and related
drugs (salicylates), cidofovir, other NSAIDs (e.g., ketorolac).If you are currently using any of these
medications listed above, tell your doctor or pharmacist before starting naproxen.Before using this
medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you
may use, especially of: anti-platelet drugs (e.g., cilostazol, clopidogrel), oral bisphosphonates (e.g.,
alendronate), "blood thinners" (e.g., enoxaparin, heparin, warfarin), corticosteroids (e.g., prednisone),
cyclosporine, desmopressin, digoxin, high blood pressure drugs (including ACE inhibitors such as
captopril, angiotensin receptor blockers such as losartan, and beta-blockers such as metoprolol),
lithium, methotrexate, pemetrexed, probenecid, SSRI antidepressants (e.g., fluoxetine, sertraline),
"water pills" (diuretics such as furosemide, hydrochlorothiazide, triamterene).Check all prescription
and nonprescription medicine labels carefully for other pain/fever drugs (NSAIDs such as aspirin,
celecoxib, ibuprofen). These drugs are similar to this medication, so taking one of these drugs while
also taking this medication may increase your risk of side effects. However, if your doctor has
prescribed low doses of aspirin to prevent heart attack or stroke (usually at dosages of 81-325
milligrams a day), you should continue to take the aspirin. Daily use of NSAIDs (e.g., ibuprofen) may
decrease aspirin's ability to prevent heart attack/stroke. Consult your doctor or pharmacist for more
details and to discuss other possible treatments (e.g., acetaminophen) for your pain/fever.This
medication can affect the results of certain lab tests. Make sure laboratory personnel and your doctors
know you use this drug.This document does not contain all possible interactions. Therefore, before
using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your
medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room
immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly. Symptoms of overdose may include:
severe stomach pain, vomit that looks like coffee grounds, extreme drowsiness, slow or shallow
breathing, seizures.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., complete
blood count, liver and kidney function tests) may be performed periodically to monitor your progress or
check for side effects. Consult your doctor for more details.Non-drug treatment for arthritis that is
approved by your doctor (e.g., weight loss if needed, strengthening and conditioning exercises) may
help improve your flexibility, range of motion, and joint function. Consult your doctor for specific
instructions.
MISSED DOSE: If you are prescribed this drug on a regular schedule (not just "as needed") and you
miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed
dose and resume your usual dosing schedule. Do not double the dose to catch up.
STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light
and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do not
flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard
this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal
company for more details about how to safely discard your product.

GENERIC NAME: ibuprofen

BRAND NAME: Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever
etc.
DRUG CLASS AND MECHANISM: Ibuprofen belongs to a class of drugs called non-steroidal antiinflammatory drugs (NSAIDs). Other members of this class include aspirin, naproxen (Aleve),
indomethacin (Indocin), nabumetone (Relafen) and several others. These drugs are used for the
management of mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation are
promoted by the release in the body of chemicals called prostaglandins. Ibuprofen blocks the enzyme
that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a
consequence, inflammation, pain and fever are reduced. The FDA approved ibuprofen in 1974.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets of 200, 400, 600, and 800 mg; Chewable tablets of 50 and 100 mg;
Capsules of 200 mg; Suspension of 100 mg/2.5 ml and 100 mg/5 ml; Oral drops of 40 mg/ml.
STORAGE: Ibuprofen should be stored at room temperature, between 15-30C (59-86F).
PRESCRIBED FOR: Ibuprofen is used for the treatment of mild to moderate pain, inflammation and
fever caused by many and diverse diseases.
DOSING: For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is
200 or 400 mg every 4 to 6 hours.
Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the
maximum dose is 1.2 g daily. Individuals should not use ibuprofen for more than 10 days for the
treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.
Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the
treatment of fever and pain. The maximum dose is 40 mg/kg daily.
Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.
Ibuprofen should be taken with meals to prevent stomach upset.
DRUG INTERACTIONS: Ibuprofen is associated with several suspected or probable interactions that
can affect the action of other drugs. Ibuprofen may increase the blood levels of lithium (Eskalith) by
reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium
toxicity. Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce
blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)]
the blood levels of the aminoglycoside may increase, presumably because the elimination of
aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should
avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to
bleeding.
PREGNANCY: There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen
is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of
premature closure of the ductus arteriosus in the fetal heart..

NURSING MOTHERS: Ibuprofen is not excreted in breast milk. Use of ibuprofen while
breastfeeding, poses little risk to the infant.
SIDE EFFECTS: The most common side effects from ibuprofen are rash, ringing in the ears,
headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn.
NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ibuprofen
may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can
occur without abdominal pain, and black, tarry stools, weakness, and dizziness upon standing
(orthostatic hypotension) due to bleeding may be the only signs of an ulcer. NSAIDs reduce the flow of
blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in
patients who already have impaired function of the kidney or congestive heart failure, and use of
NSAIDs in these patients should be cautious. People who are allergic to other NSAIDs, including
aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic
reactions to ibuprofen and other NSAIDs. Fluid retention (edema), blood clots, heart attacks,
hypertension and heart failure have also been associated with the use of NSAIDs.
WARNING: This drug may infrequently cause serious (rarely fatal) bleeding from the stomach or
intestines. Also, related drugs rarely have caused blood clots to form, resulting in heart attacks and
strokes. This medication might also rarely cause similar problems. Talk to your doctor or pharmacist
about the benefits and risks of treatment, as well as other possible medication choices.
If you notice any of the following rare but very serious side effects, stop taking ibuprofen and seek
immediate medical attention: black stools, persistent stomach/abdominal pain, vomit that looks like
coffee grounds, chest pain, weakness on one side of the body, sudden vision changes, slurred speech.
USES: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which relieves pain and swelling
(inflammation). It is used to treat headaches, muscle aches, backaches, dental pain, menstrual cramps,
arthritis, or athletic injuries. This medication is also used to reduce fever and to relieve minor aches and
pains due to the common cold or flu.This drug works by blocking the enzyme in your body that makes
prostaglandins. Decreasing prostaglandins helps to reduce pain, swelling, and fever.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using
ibuprofen and each time you get a refill. If you have any questions regarding the information, consult
your doctor or pharmacist.Take this medication by mouth with a full glass (8 ounces or 240 milliliters)
of water unless your doctor directs you otherwise. Do not lie down for at least 30 minutes after taking
this drug.If stomach upset occurs while taking this medication, take it with food, milk, or an antacid.
The dosage is based on your medical condition and response to therapy. If repeat doses are needed,
they are usually given 6 or 8 hours apart; or as directed by your doctor.When ibuprofen is used in
children, the dose is based on your child's weight. Read the product instructions to find the appropriate
dose for your child's weight. Consult the pharmacist or doctor if you have questions or if you need help
in choosing the appropriate dosage form.In certain conditions (e.g., arthritis), it may take up to two
weeks, taken regularly, before the full benefits of this drug take effect.If you are taking this drug on an
"as needed" basis (not on a regular schedule), remember that pain medications work best if they are
used as the first signs of pain occur. If you wait until the pain has significantly worsened, the medicine
may not work as well.If you use this medication for migraine headache, and the pain is not relieved or
worsens after the first dose, tell your doctor immediately.For nonprescription ibuprofen products: If
you are treating yourself or giving this medication to a child for undiagnosed fever or pain, consult the
doctor immediately if symptoms do not improve within 24 hours, worsen or last for more than 3 days,
or if new symptoms appear.To reduce your risk of stomach bleeding and other side effects, take this
medication at the lowest effective dose for the shortest possible time. Do not increase your dose, take it

more frequently, or take it for a longer time than prescribed. Do not take the over-the-counter product
for more than 10 days unless otherwise directed.
SIDE EFFECTS: Upset stomach, nausea, vomiting, heartburn, headache, diarrhea, constipation,
drowsiness, and dizziness may occur. If any of these effects persist or worsen, notify your doctor or
pharmacist promptly.If your doctor has directed you to use this medication, remember that he or she
has judged that the benefit to you is greater than the risk of side effects. Many people using this
medication do not have serious side effects.Tell your doctor immediately if any of these serious side
effects occur: stomach pain, swelling of the hands or feet, sudden or unexplained weight gain, ringing
in the ears (tinnitus).Tell your doctor immediately if any of these unlikely but serious side effects occur:
vision changes, rapid or pounding heartbeat, easy bruising or bleeding, difficult/painful swallowing.Tell
your doctor immediately if any of these highly unlikely but very serious side effects occur: change in
amount of urine, severe headache, very stiff neck, mental/mood changes, persistent sore throat or
fever.This drug may rarely cause serious (possibly fatal) liver disease. If you notice any of the
following highly unlikely but very serious side effects, stop taking ibuprofen and consult your doctor or
pharmacist immediately: yellowing eyes and skin, dark urine, unusual/extreme tiredness.An allergic
reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an
allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,
trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed
above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side
effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for
medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking ibuprofen, tell your doctor or pharmacist if you are allergic to it; or to
aspirin or other NSAIDs (e.g., naproxen, celecoxib); or if you have any other allergies.This medication
should not be used if you have certain medical conditions. Before using this medicine, consult your
doctor or pharmacist if you have: severe kidney disease, aspirin-sensitive asthma (a history of
worsening breathing with runny/stuffy nose after taking aspirin or other NSAIDs), recent heart bypass
surgery (CABG).Before using this medication, tell your doctor or pharmacist your medical history,
especially of: kidney disease, liver disease, poorly controlled diabetes, stomach/intestine/esophagus
problems (e.g., bleeding, ulcers, recurring heartburn), heart disease (e.g., congestive heart failure,
history of heart attack), high blood pressure, stroke, swelling (edema, fluid retention), dehydration,
blood disorders (e.g., anemia), bleeding or clotting problems, asthma, growths in the nose (nasal
polyps), history of an allergic reaction with symptoms of lip/tongue/throat swelling (angioedema), any
allergies in addition to those listed above.This drug may make you dizzy or drowsy. Do not drive, use
machinery, or do any activity that requires alertness until you are sure you can perform such activities
safely. Limit alcoholic beverages.This medicine may cause stomach bleeding. Daily use of alcohol and
tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding.
Limit alcohol and stop smoking. Consult your doctor or pharmacist for more information.This
medication may make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths or
sunlamps. Use a sunscreen and wear protective clothing when outdoors.Caution is advised when using
this drug in the elderly because they may be more sensitive to the side effects of the drug, especially
stomach bleeding and kidney effects.This medication should be used only when clearly needed during
the first 6 months of pregnancy. It is not recommended for use during the last 3 months of pregnancy
due to the potential for harm to an unborn baby and interference with normal labor/delivery. Discuss
the risks and benefits with your doctor.This medication passes into breast milk. While there have been
no reports of harm to nursing infants, consult your doctor before breast-feeding.

DRUG INTERACTIONS: Your healthcare professionals (e.g., doctor or pharmacist) may already be
aware of any possible drug interactions and may be monitoring you for it. Do not start, stop or change
the dosage of any medicine before checking with them first.This drug should not be used with the
following medications because very serious interactions may occur: cidofovir, ketorolac.If you are
currently using any of these medications listed above, tell your doctor or pharmacist before starting
ibuprofen.Before using this medication, tell your doctor or pharmacist of all prescription and
nonprescription/herbal products you may use, especially of: anti-platelet drugs (e.g., cilostazol,
clopidogrel), oral bisphosphonates (e.g., alendronate), other medications for arthritis (e.g., aspirin,
methotrexate), "blood thinners" (e.g., enoxaparin, heparin, warfarin), corticosteroids (e.g., prednisone),
cyclosporine, desmopressin, high blood pressure drugs (including ACE inhibitors such as captopril,
angiotensin II receptor antagonists such as losartan, and beta-blockers such as metoprolol), lithium,
pemetrexed, "water pills" (diuretics such as furosemide, hydrochlorothiazide, triamterene).Check all
prescription and nonprescription medicine labels carefully for other pain/fever drugs (NSAIDs such as
aspirin, celecoxib, naproxen). These drugs are similar to ibuprofen, so taking one of these drugs while
also taking ibuprofen may increase your risk of side effects. Consult your doctor or pharmacist for
more details.However, if your doctor has prescribed low doses of aspirin to prevent heart attack or
stroke (usually at dosages of 81-325 milligrams a day), you should continue to take the aspirin. Daily
use of ibuprofen may decrease aspirin's ability to prevent heart attack/stroke. Talk to your doctor about
using a different medication (e.g., acetaminophen) to treat pain/fever. If you must take ibuprofen, talk
to your doctor about possibly taking immediate-release aspirin (not enteric-coated) while also taking
the ibuprofen dose apart from your aspirin dose. Do not increase your daily dose of aspirin or change
the way you take aspirin/other medications without your doctor's approval.This document does not
contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of
all the products you use. Keep a list of all your medications with you, and share the list with your
doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room
immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly. Symptoms of overdose may include:
severe stomach pain, coffee ground-like vomit, unusually fast or slow heartbeat, trouble breathing,
extreme drowsiness, loss of consciousness, or seizures.
NOTES: Do not share this medication with others.Laboratory and/or medical tests may be performed
periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you are prescribed this drug on a regular schedule (not just "as needed") and you
miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose
and resume your usual dosing schedule. Do not double the dose to catch up.
STORAGE: Store at room temperature between 59 and 86 degrees F (15-30 degrees C) away from
light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.Do
not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly
discard this product when it is expired or no longer needed. Consult your pharmacist or local waste
disposal company for more details about how to safely discard your product.

GENERIC NAME: gabapentin

BRAND NAME: Neurontin, Gabarone
DRUG CLASS AND MECHANISM: Gabapentin is an anticonvulsant that is used for preventing
seizures and for treating postherpetic neuralgia. The mechanism of action of gabapentin is not known.
Gabapentin structurally resembles the neurotransmitter gamma aminobutyric acid (GABA). It is
possible that this similarity is related to gabapentin's mechanism of action. In animal models used for
testing the anticonvulsant and analgesic activity of drugs, gabapentin prevents seizures and reduces
pain-related responses. The FDA approved gabapentin in December 1993.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:
Capsules: 100, 300, and 400 mg.
Tablets: 100, 300, 400, 600, and 800 mg.
Solution: 250 mg/5 ml
STORAGE: Tablets and capsules should be stored between 15-30 C (59-86 F). Gabapentin solution
should be refrigerated between 2-8 C (36-46 F).
PRESCRIBED FOR: Gabapentin is approved for treating seizure disorders and nerve damage from
herpes zoster (shingles, postherpetic neuralgia). There are many non-approved uses for gabapentin.
These include alcohol withdrawal, cocaine withdrawal, hiccups, restless leg syndrome, hyperhidrosis,
headaches, diabetic neuropathy, hot flashes, and fibromyalgia.
DOSING: Gabapentin may be taken with or without food. The recommended dose for postherpetic
neuralgia is 1800 mg daily in 3 divided doses. The initial dose of 300 mg daily is increased over several
days to the recommended daily dose. Seizures are treated with 900-1800 mg/daily in 3 divided doses.
Withdrawal of treatment should occur slowly over a week.
DRUG INTERACTIONS: Antacids reduce the concentration of gabapentin in blood. Therefore,
gabapentin should be administered 2 hours or more after taking antacids. Morphine significantly
increases blood concentrations of gabapentin and may increase central nervous system-related adverse
events associated with gabapentin.
PREGNANCY: Safety in pregnancy has not been established.
NURSING MOTHERS: Gabapentin is secreted in human breast milk. Nursing mothers should only
use gabapentin if the benefits outweigh the unknown risk to the fetus.
SIDE EFFECTS: Common side effects of gabapentin are dizziness, somnolence, ataxia, fatigue, fluid
retention, hostility, nausea and vomiting. Other adverse events associated with gabapentin include
hypertension, anorexia, bruising, joint pain, motion sickness, and pneumonia.
Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior.
Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical
need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal
thoughts, or unusual changes in behavior.
USES: Gabapentin is used with other medications to help control seizures in adults and children (3
years of age and older). It is also used to relieve nerve pain associated with shingles (herpes zoster)

infection in adults.OTHER This section contains uses of this drug that are not listed in the approved
professional labeling for the drug but that may be prescribed by your health care professional. Use this
drug for a condition that is listed in this section only if it has been so prescribed by your health care
professional.Gabapentin may also be used to treat other nerve pain conditions (e.g., diabetic
neuropathy, peripheral neuropathy, trigeminal neuralgia).
HOW TO USE: Take this medication by mouth, with or without food, as directed by your doctor. The
dosage is based on your medical condition and response to therapy. During the first few days, your
doctor may gradually increase your dose so your body can adjust to the medication. To minimize side
effects, take the very first dose at bedtime.Use this medication regularly in order to get the most benefit
from it. This drug works best when the amount of medicine in your body is kept at a constant level.
Therefore it is best to take gabapentin at evenly spaced intervals throughout the day and night.Do not
take this medication more often or increase your dose without consulting your doctor. Your condition
will not improve any faster and the risk of serious side effects may be increased.Do not stop taking this
medication without consulting your doctor. Some conditions such as seizures may become worse when
the drug is abruptly stopped. Your dose may need to be gradually decreased.Antacids containing
aluminum or magnesium may interfere with the absorption of this medication. Therefore it is best to
take gabapentin at least 2 hours after taking an antacid.Inform your doctor if your condition does not
improve or worsens.
SIDE EFFECTS: Drowsiness, dizziness, unsteadiness, fatigue, vision changes, weight gain, nausea,
dry mouth, or constipation may occur. If any of these effects persist or worsen, notify your doctor or
pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has
judged that the benefit to you is greater than the risk of side effects. Many people using this medication
do not have serious side effects.Tell your doctor immediately if any of these serious side effects occur:
tremor or shaking, swollen arms/legs.Tell your doctor immediately if any of these unlikely but serious
side effects occur: loss of coordination.A small number of people who take anticonvulsants for any
condition (such as seizure, bipolar disorder, pain) may experience depression, suicidal
thoughts/attempts, or other mental/mood problems. Tell your doctor immediately if you or your
family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including
signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.Tell your doctor
immediately if any of these highly unlikely but very serious side effects occur: persistent sore
throat/fever/cough, unusual bleeding/bruising, pain/redness of arms or legs, trouble breathing,
fast/slow/irregular heartbeat, hearing loss, stomach/abdominal pain.A very serious allergic reaction to
this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic
reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness,
trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed
above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side
effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada - Call your doctor for
medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking gabapentin, tell your doctor or pharmacist if you are allergic to it; or
if you have any other allergies.Before using this medication, tell your doctor or pharmacist your
medical history, especially of: kidney disease.This drug may make you dizzy or drowsy. Do not drive,
use machinery, or do any activity that requires alertness until you are sure you can perform such
activities safely. Limit alcoholic beverages.Caution is advised when using this drug in the elderly
because they may be more sensitive to its effects, especially swollen arms/legs or loss of
coordination.Caution is advised when using this drug in children because they may be more sensitive to
its effects, especially the mental/mood changes (e.g., hostility).This medication should be used only
when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.Gabapentin

passes into breast milk. Because the effects of this drug on the nursing infant are unknown, consult
your doctor before breast-feeding.
DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug
interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any
medicine before checking with them first.See also How to Use section.Before using this medication,
tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use,
especially of: antacids containing aluminum or magnesium, morphine.This product can affect the
results of certain lab tests for urine protein. Make sure laboratory personnel and your doctors know you
use this drug.This document does not contain all possible interactions. Therefore, before using this
product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications
with you, and share the list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room
immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian
residents should call their local poison control center directly. Symptoms of overdose may include:
severe drowsiness, slurred speech, or extreme lethargy.
NOTES: Do not share this medication with others.
MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next
dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
STORAGE: Store at room temperature (77 degrees F or 25 degrees C) away from light and moisture.
Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom.
Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them
into a drain unless instructed to do so. Properly discard this product when it is expired or no longer
needed. Consult your pharmacist or local waste disposal company for more details about how to safely
discard your product.MEDICAL ALERT: Your condition can cause complications in a medical
emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507
(Canada).
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