NEUROPATHIC PAIN-ANTICONVULSANTS

SUMMARY

1. Gabapentin: diabetic neuropathy, post-herpetic neuralgia. Improves sleep, mood, and quality of life at dosages of 1800-3600 mg/day. SE: somnolence, dizziness. There is a non-linear relationship between serum concentration & dosage.

2. Pregabalin: α₂δ ligand and is structurally related to gabapentin but with no intrinsic GABA activity. Management of postherpetic neuralgia, diabetic peripheral neuropathy, general peripheral neuropathy, fibromyalgia and generalized anxiety disorder with doses at 150-600 mg/day. Rapid onset of action (within 1 hour), stable bioavailability independent of dose.

3. Lamotrigine: blocks voltage-dependent sodium channels and N-type calcium channels, and inhibits glutamate release. Dosage: 50-400mg/day. For trigeminal neuralgia & central post-stroke pain.

4. Oxcarbazepine: analogue of carbamazepine. Shown efficacy in patients with postherpetic neuralgia, trigeminal neuralgia, and diabetic peripheral neuropathy at doses averaging at 600-1200 mg/day.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.