Treatment of Neuropathic Pain – Gabapentin (Neurontin®)

Gabapentin can be an antiepileptic medication (AED) analyzed for various kinds of neuropathic pain. It’s FDA-approved for your treatment of PHN and as adjunct therapy for partial onset seizures. Clinical trials have shown excellent results for the treatment of PHN and painful polyneuropathy, and mixed results for your treatment of phantom limb pain and painful diabetic neuropathy. Gabapentin was ineffective in reports of advanced regional pain syndrome -induced HIV neuropathy, and neuropathy. Gabapentin is preferred as a primary-line treatment choice for central neuropathic pain, postherpetic neuralgia, and unpleasant polyneuropathies EFNS from the AISP, and CPS CPS.


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The dose should be titrated by 100 to 300 mg every 3 to seven days as accepted to a maximum amount of 3600 mg per day. The most common effective dose is 1800 mg to 3600 mg each day, that might take several weeks to achieve. Because of the gradual dose titration, an adequate trial usually takes more than 2 weeks. It has minimum drug interactions since it isn’t metabolized and does not restrict or induce hepatic enzymes. However, a dose reduction is necessary inpatients with renal insufficiency. It might also help improve sleep.

A Cochrane review included studies of gabapentin for your treatment of various kinds of chronic pain. This analysis included four placebo-controlled trials (281 patients) of gabapentin 900 to 3600 mg daily for that treatment of painful diabetic neuropathy. The combined NNT for effective pain alleviation in these four reports was 4.3 (95% CI 3.5–5.7); that is, 64% of patients increased on gabapentin in contrast to 28% on placebo. Several control studies comparing gabapentin to amitriptyline for that treatment of painful diabetic neuropathy were also reported. An additional study of 25 patients concluded that gabapentin (1200–2400 mg every day) was better than amitriptyline (30–90 mg daily), but these results weren’t statistically significant. The third study involved only seven patients who had benefit from gabapentin in a previous study. The outcomes with this review were not evaluable.

Sleep is the most typical dose-limiting side effect and is decreased by beginning using a lower dose and titrating gradually. Somnolence and dizziness would be the most common side effects, and can often be handled by a slow titration. Gabapentin may increase the danger of drops and the elderly are more prone to these unwanted side effects and worsen cognitive impairment in this patient population. The slow-dose titration and beginning of motion, 3 x daily dosing schedule and side effects of weight gain, and sleep, edema, dizziness might restrict the usage of gabapentin for some people.

Members received each treatment for 6 days followed by an one week taper plus an one-week washout phase. Pain scores were significantly lower throughout the combination stage than for either therapy alone. Nortriptyline and gabapentin monotherapy monotherapy were equally effective. Dry mouth was prevalent with nortriptyline and difficulty concentrating was more common with gabapentin.