# Trigeminal neuralgia - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025 · AAN/EFNS Guidelines · Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Nervous System Disorders 2025 - Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph) - Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt) - Egyptian National Drug Formulary (endf-nervous-2025.txt) ## Treatment metadata - Carbamazepine — 200 mg — oral.solid - Referral & safety-netting (no drug therapy) - Oxcarbazepine — 300 mg — oral.solid - Phenytoin — 100 mg — oral.solid ## Complete treatment card ```text TRIGEMINAL NEURALGIA Sources: Egyptian National Drug Formulary - Nervous System Disorders 2025 · AAN/EFNS Guidelines · Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph) Review status: REVIEWED against Egyptian National Drug Formulary - Nervous System Disorders 2025, Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph), Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia-clinical.txt), Egyptian National Drug Formulary (endf-nervous-2025.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Attacks are described as severe, electric-shock or shooting pain lasting a fraction of a second up to about 2 minutes [burning pain · shock] - Pain is typically one-sided, and the right side is affected more often than the left - Attacks almost never occur during sleep - Light touch to a specific trigger zone, often near the midline of the nose or mouth, can bring on or reproduce the pain - Other reported triggers include brushing teeth, shaving, washing the face, smoking, chewing, talking, grimacing, or cold air - Mild autonomic features like tearing, a runny nose, or eye redness can occur when the V1 division is involved [eye discharge · eye redness · runny nose] SIGNS - what you find (3) - A trigger zone, when found, is nearly pathognomonic, though not every patient has one - Routine neurologic exam usually shows no focal deficit - Sensory loss in the nerve's distribution, a lost corneal reflex, or facial weakness suggests a secondary cause rather than classic disease [facial weakness · numbness] TESTS (3) - MRI with MR angiography is recommended for anyone with a clinical diagnosis, and MRI is preferred over CT - An ordinary, non-painful touch to the affected area triggering the pain is part of the diagnostic criteria - Age under 40, bilateral symptoms, or sensory loss on exam raise the risk of a secondary cause behind the neuralgia IF NOT THIS - what else fits (8) - Postherpetic neuralgia following an episode of shingles is on the differential - Dental or tooth-related pain is on the differential for facial pain - Short-lasting unilateral neuralgiform headache attacks (SUNA) are on the differential - SUNCT (with conjunctival injection and tearing) is on the differential - Trigeminal neuropathy is on the differential - Temporomandibular joint syndrome is on the differential - Glossopharyngeal neuralgia is on the differential - Multiple sclerosis should be considered in a younger patient, especially with associated weakness, numbness, vision change, dizziness, or unsteady gait Source StatPearls "Trigeminal Neuralgia" - disease-level clinical article Status traced to the source above 1. CARBAMAZEPINE [1st line] Adult 100 mg twice daily initially, increase gradually to 200 mg 3-4 times daily (usual maintenance 600-800 mg daily; max 1200 mg daily) - long-term Peds Trigeminal neuralgia is extremely rare in children; specialist referral required Source Egyptian National Drug Formulary - Nervous System Disorders 2025 Why Anticonvulsant that stabilises voltage-gated sodium channels to dampen the paroxysmal neuronal firing responsible for trigeminal neuralgia pain; the established first-line drug therapy for this condition. Caution Monitor complete blood count and liver enzymes (risk of agranulocytosis, aplastic anemia, and hepatotoxicity). Screen for HLA-B*1502 allele in patients of Asian ancestry (high risk of Stevens-Johnson syndrome). Hyponatremia (SIADH-like) can occur. Carbamazepine is a potent CYP3A4 inducer with multiple drug interactions. Egypt CARBAMAZEPIN 200MG 10 TAB.U.S.P.33 SEDICO 3.00 EGP (0.30/unit) CARBAMAZEPINE 200MG XR 10 TAB. SIGMA 4.00 EGP (0.40/unit) TONOCLONE 200MG 30 TAB. UP PHARMA 13.50 EGP (0.45/unit) CARBATOL 200 MG 20 TABS. AMOUN 37.00 EGP (1.85/unit) MAZEMAL 200 MG 20 TABS. UNIPHARMA 52.00 EGP (2.60/unit) CARBAPEX 200 MG CR 30 TABS. MULTI-APEX 81.00 EGP (2.70/unit) TEGRETOL CR 200MG 20 F.C. DIVITAB. NOVARTIS 61.00 EGP TEGRAL 200 MG 50 SCORED TABS. CID 140.00 EGP ALEXTOL 100MG/5ML ORAL SUSP. 100ML ALEXANDRIA 7.50 EGP -> ? strength differs, ? different route - not oral solid ARBATEG 2% SUSP. 100 ML MEDIZEN PHARM... 35.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Trigeminal Neuralgia - disease-level clinical article (trigeminal-neuralgia- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - HLA-B*15:02 allele testing is recommended before starting carbamazepine (and applies to oxcarbazepine too) because of the risk of toxic epidermal necrolysis/Stevens- Johnson syndrome. RED FLAG - The exam and history features suggesting secondary trigeminal neuralgia, which needs neuroimaging and a different pathway rather than just first-line drug treatment, are sensory loss, absent corneal reflex, facial weakness, or young age at onset (which raises suspicion for multiple sclerosis). RED FLAG - Neither carbamazepine nor oxcarbazepine gives immediate relief; response should not be assessed before 2 weeks of therapy. RED FLAG - Surgical referral (e.g. microvascular decompression) is recommended once maximal medical therapy has failed. 3. OXCARBAZEPINE [2nd line] Adult 300 mg twice daily initially, increase by 300 mg every 3-5 days to effective dose (usual 600-1200 mg daily in divided doses; max 2400 mg daily) - long-term Peds Specialist pediatric neurology referral required Choice Oxcarbazepine is the first choice here; phenytoin is an alternative. Source Egyptian National Drug Formulary - Nervous System 2025 (oxcarbazepine monograph) Why Better tolerated alternative to carbamazepine with fewer drug interactions Caution Oxcarbazepine has a higher incidence of hyponatremia than carbamazepine; monitor serum sodium. There is cross-reactivity in 25-30% of patients with carbamazepine hypersensitivity. Dose adjustment is required in renal impairment (CrCl < 30 mL/min). Egypt ANDOXEZINE 300 MG 30 F.C. TABS. ANDALOUS PHARMA 37.50 EGP (1.25/unit) OXATRILEPAZINE 300 MG 60 F.C.TAB MEDIZEN PHARM... 96.75 EGP (1.61/unit) OXIGREX 300MG 30 F.C.TAB. HORUS FOR PHA... 56.25 EGP (1.88/unit) OXALEPTAL 300 MG 30 F.C.TABS. MASH PREMIERE 180.00 EGP (6.00/unit) SHORSALIN 300 MG 30 F.C.TAB GLOBAL NAPI P... 180.00 EGP (6.00/unit) TRILEPTAL 300MG 50 F.C.TAB. NOVARTIS 356.00 EGP (7.12/unit) OXALEPTAL 60MG/ML ORAL SUSP. 100ML MASH PREMIERE 105.00 EGP -> ? strength differs, ? different route - not oral solid TRILEPTAL 60MG/ML ORAL SUSP. 100 ML NOVARTIS 160.00 EGP -> ? strength differs, ? different route - not oral solid 4. PHENYTOIN [2nd line] Adult Oral: 300-500 mg. Adjust dose if required. - long-term Peds 4-8 mg/kg/day [child max 300 mg] (Children and infants: Initial 5 mg/kg/day in 2 or 3 divided doses; maintenance 4 to 8 mg/kg/day in divided doses; maximum 300 mg daily.) 3kg -> 12-24 mg/day 4kg -> 16-32 mg/day 5kg -> 20-40 mg/day 6kg -> 24-48 mg/day 7kg -> 28-56 mg/day 8kg -> 32-64 mg/day 9kg -> 36-72 mg/day 10kg -> 40-80 mg/day 11kg -> 44-88 mg/day 12kg -> 48-96 mg/day 13kg -> 52-104 mg/day 14kg -> 56-112 mg/day 15kg -> 60-120 mg/day 16kg -> 64-128 mg/day 17kg -> 68-136 mg/day 18kg -> 72-144 mg/day 19kg -> 76-152 mg/day 20kg -> 80-160 mg/day 21kg -> 84-168 mg/day 22kg -> 88-176 mg/day 23kg -> 92-184 mg/day 24kg -> 96-192 mg/day 25kg -> 100-200 mg/day 26kg -> 104-208 mg/day 27kg -> 108-216 mg/day 28kg -> 112-224 mg/day 29kg -> 116-232 mg/day 30kg -> 120-240 mg/day 31kg -> 124-248 mg/day 32kg -> 128-256 mg/day 33kg -> 132-264 mg/day 34kg -> 136-272 mg/day 35kg -> 140-280 mg/day 36kg -> 144-288 mg/day 37kg -> 148-296 mg/day 38kg -> 152-300 mg/day (upper capped) 39kg -> 156-300 mg/day (upper capped) 40kg -> 160-300 mg/day (upper capped) 41kg -> 164-300 mg/day (upper capped) 42kg -> 168-300 mg/day (upper capped) 43kg -> 172-300 mg/day (upper capped) 44kg -> 176-300 mg/day (upper capped) 45kg -> 180-300 mg/day (upper capped) 46kg -> 184-300 mg/day (upper capped) 47kg -> 188-300 mg/day (upper capped) 48kg -> 192-300 mg/day (upper capped) 49kg -> 196-300 mg/day (upper capped) 50kg -> 200-300 mg/day (upper capped) Source Egyptian National Drug Formulary (endf-nervous-2025.txt) Why Second-line antiepileptic for trigeminal neuralgia when carbamazepine or oxcarbazepine fail; the formulary notes its effects may be short-lived and it is considered a bridging therapy. Caution Ataxia, dysarthria, nystagmus, gingival enlargement, cardiac arrhythmias, anemia, and teratogenicity can occur. There is a relatively small margin between full therapeutic effect and minimally toxic doses of this drug. Phenytoin should be discontinued at the first sign of a rash. Egypt EPANUTIN 100MG 50CAPS. EL NILE. > PF... 14.40 EGP (0.29/unit) PHENYTOIN 100MG 40 CAPS. EL NASR 16.00 EGP (0.40/unit) IPANTEN 100MG 50 CAPS. ARAB CAPS > A... 51.00 EGP (1.02/unit) PHENYTIN 100MG 50 CAPS. EL NILE. 51.00 EGP (1.02/unit) IPANTEN 30MG/5ML SUSP. 125ML T3A PHARMA > ... 13.50 EGP -> ? strength differs, ? different route - not oral solid PHENYTIN 30MG/5ML SUSP. 120 ML EL NILE. 19.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)