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Clin Ther. 2003 Mar;25(3):852-89. Links
The use of gabapentin for the treatment of postherpetic neuralgia.
Singh D, Kennedy DH.
Pharmacy Practice, Nova Southeastern University College of Pharmacy-Davie
Campus, Fort Lauderdale, Florida 33328-2018, USA. singh@nova.edu
BACKGROUND: Varicella-zoster virus causes chickenpox and can reemerge
later in life to cause herpes zoster or shingles. One of the most common
and disabling complications of herpes zoster is postherpetic neuralgia
(PHN). OBJECTIVES: This article reviews the current primary literature
about the efficacy and tolerability of gabapentin for the treatment of
PHN. Gabapentin pharmacokinetics and drug interactions are also reviewed.
METHODS: A literature search in the English language was conducted using
OVID Web, which contained the following databases: MEDLINE (1966-present),
EMBASE (1980-2002), Current Contents/Clinical Medicine (1999-2002),
Cochrane Controlled Trials Register (1898-present), Cochrane Database of
Systemic Reviews (fourth quarter, 2002), and International Pharmaceutical
Abstracts (1970-2002). Search terms used were postherpetic neuralgia;
zoster; gabapentin; neuropathic pain; pain; pharmacoeconomic; cost;
controlled clinical trial; randomized, controlled trial; postherpetic
neuralgia and gabapentin; gabapentin and pain; treatment and postherpetic
neuralgia; gabapentin and age; gabapentin and gender; gabapentin and
ethnicity; and gabapentin and pharmacokinetics. RESULTS: Gabapentin
displays nonlinear absorption kinetics, is minimally protein bound (< 3%),
has a high mean (SD) volume of distribution (50.4 [8.0] L), and is
excreted via the kidneys as unchanged drug. Two randomized,
placebo-controlled, parallel-group, multicenter clinical trials
demonstrated the effectiveness of gabapentin at doses of up to 3600 mg/d
to significantly reduce pain (P < 0.01 and P < 0.001), improve sleep (P <
0.01), and improve some parameters on the Short Form-McGill Pain
Questionnaire (P < 0.05). Dizziness and somnolence were the most common
side effects leading to withdrawal from the trials. The recommended dosage
in adults is 300 mg at bedtime on day 300 mg BID on day 2, and 300 mg TID
on day 3, titrating up as needed to 2400 to 3600 mg/d. To reduce adverse
events in patients with renal impairment, the dose should be adjusted
based on the patient's creatinine clearance. CONCLUSIONS: Gabapentin
appears to be effective and well tolerated for the short-term treatment of
PHN. However, future controlled studies are needed to determine whether
the effectiveness of gabapentin for PHN is maintained for > 2 months, to
establish the optimal dose of gabapentin for PHN, and to compare the
efficacy of gabapentin with that of other pharmacologic agents used for
the treatment of PHN.
Publication Types:
Review
Review, Tutorial
PMID: 12852705 [PubMed - indexed for MEDLINE] |
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