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May 23, 1990

Fluphenazine and Postherpetic Neuralgia

JAMA. 1990;263(20):2750. doi:10.1001/jama.1990.03440200052020

To the Editor.—  Dr Murphy's1 review of the treatment of postherpetic neuralgia makes a highly questionable statement about how to treat this difficult problem. Dr Murphy states that "current practice suggests that the combination of fluphenazine hydrochloride... combined with a tricyclic antidepressant... may be effective." Although he cautions against the casual use of fluphenazine because of its extrapyramidal side effects, his recommendation is nevertheless too permissive and therefore deserves a response. Fluphenazine has been popular in the treatment of various pain syndromes, but it has never been shown in control trials to be effective, especially in postherpetic neuralgia, whereas amitriptyline has passed the litmus test of a double-blind, randomized, crossover study.2 Since the incidence of herpes zoster increases with age, this very same group of elderly is most prone to develop irreversible tardive dyskinesia. Therefore, a strict warning against the use of fluphenazine or any of the neuroleptic