Monday, February 25, 2019

Gabapentin for PHN

Gabapentin — There is moderate-quality evidence supporting the efficacy of gabapentin for PHN, but not all trials have shown a statistically significant benefit, particularly for the extended-release formulation of gabapentin, and outcomes are not well studied beyond 12 weeks .

A 2017 systematic review identified eight placebo-controlled randomized trials comparing various formulations of gabapentin in over 2200 patients with moderate to severe pain due to PHN . In a meta-analysis, gabapentin at doses between 1200 and 3600 mg daily was associated with higher rates of substantial benefit (at least 50 percent reduction in pain intensity or "very much improved" pain) than placebo (32 versus 17 percent, risk ratio 1.8, 95% CI 1.5-2.1, number needed to treat 6.7). In a pooled analysis of side effects across 37 trials for multiple types of neuropathic pain, withdrawal due to adverse effects was more common with gabapentin than placebo (11 versus 8 percent). The most common adverse effects were somnolence or drowsiness (14 versus 5 percent), dizziness (19 versus 7 percent), peripheral edema (7 versus 2 percent), and ataxia or gait disturbance (14 versus 3 percent). The rate of serious adverse effects was 3 percent in both groups.

Gabapentin is typically started at a low dose and titrated to effect. Our suggested gabapentin regimen for PHN is 300 mg on day 1, 300 mg twice daily on day 2, and 300 mg three times daily on day 3; the dose is then titrated as needed for pain relief to the range of 1800 to 3600 mg/day in three divided doses. For the extended-release formulation of gabapentin, one regimen begins with 300 mg on day 1, 600 mg on day 2, 900 mg once daily on days 3 to 6, 1200 mg once daily on days 7 to 10, 1500 mg once daily on days 11 to 14, and 1800 mg once daily on day 15 and thereafter.

Bhopalwala. H

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