Category Name Neuro / Neuropathic Pain Management
Common Indications EVONOR-M is indicated for the management of neuropathic pain arising from nerve damage or dysfunction. It is commonly prescribed for:
- Diabetic peripheral neuropathy with associated burning, tingling, and shooting pain
- Post-herpetic neuralgia (nerve pain following shingles)
- Fibromyalgia and widespread musculoskeletal pain
- Neuropathic pain associated with spinal cord injury
- Peripheral neuropathy due to vitamin B12 deficiency
- Chronic nerve pain associated with chemotherapy or other systemic conditions
- Mixed neuropathic and musculoskeletal pain requiring combined analgesic and neuroprotective therapy
Common Dosings One tablet orally, once or twice daily as prescribed — preferably at bedtime to minimise daytime drowsiness — or as directed by your physician. The dose and duration of therapy should be determined by the treating physician based on the severity of neuropathic pain, the patient's clinical response, and tolerability. Do not abruptly stop this medication without consulting your doctor, as gradual dose tapering may be required.
Common Side Effects The following side effects may occur during the course of treatment. Consult your doctor if any of these persist or worsen:
- Dizziness and uncoordinated body movements
- Sleepiness or excessive drowsiness
- Tiredness or fatigue
- Dryness of mouth
- Blurred vision
- Constipation
- Nausea or vomiting
- Diarrhoea
- Headache
- Weight gain
- Decreased appetite
- Difficulty in urination
- Increased heart rate (palpitations)
- Orthostatic hypotension (sudden drop in blood pressure upon standing) — rise slowly from a sitting or lying position to minimise this effect
- Serious allergic reactions such as rash, swelling, or difficulty breathing — seek immediate medical attention if severe
Common Interactions Inform your doctor about all medications, supplements, and herbal products you are currently taking. Notable interactions include:
- Alcohol & CNS Depressants (Benzodiazepines, Opioids, Sedatives): Concurrent use may significantly increase drowsiness, dizziness, and impaired coordination — strictly avoid combination use
- MAO Inhibitors: Concomitant use with Nortriptyline is contraindicated and may lead to life-threatening reactions — a washout period is mandatory before switching
- SSRIs & Other Antidepressants: May interact with Nortriptyline, increasing the risk of serotonin syndrome characterised by agitation, rapid heartbeat, and excessive sweating — seek immediate medical attention if these symptoms occur
- Antihistamines & Antipsychotic Medications: Pregabalin may enhance their sedative effects — use only under strict medical supervision
- Other CNS-Acting or Sedative Drugs: Combining with any medication that affects the central nervous system may cause excessive CNS depression — always inform your doctor of all concurrent medications
Special Instructions
| Condition | Guidance |
|---|---|
| Pregnancy | Safety during pregnancy has not been established. Use only if clearly indicated and under strict medical supervision. Potential risks to the foetus must be carefully evaluated by the treating physician. |
| Breastfeeding | May be unsafe during lactation. Consult your doctor before use to assess the benefit-risk profile for both mother and infant. |
| Alcohol | Strictly avoid alcohol during therapy. Concurrent use may cause excessive drowsiness, dizziness, and dangerous CNS depression. |
| Driving & Machinery | This medicine may significantly impair alertness, coordination, and reaction time. Avoid driving or operating heavy machinery until you know how this medication affects you. |
| Liver Disease | Use with caution in patients with hepatic impairment. Regular liver function monitoring and dose adjustment may be required — consult your physician before use. |
| Kidney Disease | Use with caution in patients with renal impairment. Pregabalin is primarily excreted by the kidneys — dose adjustment based on creatinine clearance may be required. Consult your physician before use. |
Mechanism of Action EVONOR-M combines three active ingredients, each working through a distinct and complementary mechanism to provide comprehensive neuropathic pain relief:
- Pregabalin (75 mg): An alpha-2-delta (α2δ) ligand that modulates voltage-gated calcium channels in the central and peripheral nervous system. By reducing calcium influx at nerve terminals, it decreases the release of excitatory neurotransmitters, thereby dampening abnormal pain signalling and providing effective relief from neuropathic pain
- Nortriptyline (10 mg): A tricyclic antidepressant (TCA) that inhibits the reuptake of serotonin and noradrenaline in the brain. By increasing the levels of these neurotransmitters, it enhances the brain's descending pain inhibitory pathways, effectively reducing the transmission and perception of pain signals
- Methylcobalamin (1500 mcg): An active, neurologically bioavailable form of Vitamin B12 that plays a critical role in myelin sheath synthesis — the protective coating around nerve fibres. It supports the regeneration of damaged nerve cells, promotes axonal transport, and helps restore normal nerve function, addressing the underlying nerve damage contributing to neuropathic pain
Together, these three components provide synergistic relief by targeting multiple pathways involved in neuropathic pain — calcium channel modulation, neurotransmitter regulation, and nerve fibre protection and repair.
Instructions to Take
- Take this tablet exactly as prescribed by your doctor
- Preferably take at bedtime after a meal to minimise daytime drowsiness and reduce the risk of stomach discomfort
- Swallow the tablet whole with a full glass of water — do not crush, split, or chew
- Take at the same time each day to maintain consistent drug levels in the body
- Do not abruptly discontinue this medication — gradual dose tapering under medical supervision is recommended to avoid withdrawal symptoms
- Do not self-medicate, adjust the dose, or alter the dosing schedule without consulting your doctor
- If a dose is missed, take it as soon as you remember — however, skip the missed dose if it is almost time for the next scheduled dose. Do not double the dose to make up for a missed one
- Strictly avoid alcohol throughout the course of treatment
- Rise slowly from a sitting or lying position to minimise the risk of dizziness or sudden drop in blood pressure
- Keep out of reach of children
- Store in a cool, dry place away from direct sunlight and moisture
Disclaimer: This information is intended for general reference purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before starting, changing, or stopping any medication.
