三叉神経痛の薬物療法

Pharmacological Treatment of Trigeminal Neuralgia

Point

・三叉神経痛の薬物療法の第一選択薬はカルバマゼピンである．

・カルバマゼピンの有効性は高いが，副作用や効果減弱による離脱率が高い薬剤である．

・カルバマゼピンの代替薬として，ガバペンチン，プレガバリン，ミロガバリン，バクロフェン，ラモトリギン，リドカイン静注，A型ボツリヌス毒素が挙げられる．

・薬物療法を開始する際には，少量から開始し，緩徐に増量する．

　Although carbamazepine is the first-line treatment option for trigeminal neuralgia, it may not be sustained long-term. The benefits of carbamazepine are offset by adverse effects that lead to its withdrawal. The alternatives to carbamazepine include gabapentin, pregabalin, and microgabalin. Although used off-label in Japan, baclofen, lamotrigine, intravenous lidocaine, and botulinum toxin type A are also effective. Clinical experience has shown that alternative treatments are less effective than carbamazepine. Therefore, they can be used instead of or in addition to carbamazepine.

　The adverse effects of drugs include drowsiness, dizziness, rash, bone marrow suppression, and liver dysfunction. Carbamazepine and lamotrigine are particularly likely to cause severe drug eruptions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Low-dose titration is important to avoid the development of rashes and adverse effects.