COMPARISON OF PREGABALIN AND NORTRIPTYLINE ON EFFICACY AND SAFETY IN POSTHERPETIC NEURALGIA

KANIKA KHAJURIA; SEEMA GUPTA; DEV RAJ DOGRA; DINESH KUMAR; VIJAY KHAJURIA

doi:10.22159/ajpcr.2021.v14i7.41872

Authors

KANIKA KHAJURIA Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India.
SEEMA GUPTA Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India.
DEV RAJ DOGRA Department of Dermatology and Venereology, Government Medical College, Jammu, Jammu and Kashmir, India.
DINESH KUMAR Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India.
VIJAY KHAJURIA Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India.

DOI:

https://doi.org/10.22159/ajpcr.2021.v14i7.41872

Keywords:

Postherpetic neuralgia, Pregabalin, Nortriptyline, Numerical rating scale, Leeds assessment of neuropathic symptoms and signs

Abstract

Objectives: Antidepressants and anticonvulsants are most commonly prescribed in postherpetic neuralgia (PHN). The aim of the present study was to compare the efficacy and safety of pregabalin and nortriptyline in patients of PHN.

Methods: The present study was conducted in 48 patients of PHN attending outpatient department of Dermatology, GMC Jammu. After obtaining written consent, the enrolled patients were randomized into two groups, one group was given pregabalin 150 mg orally per day, and other group was treated with nortriptyline 25 mg orally per day and were followed up to 8 weeks. Patients were assessed on numerical rating scale (NRS), Leeds assessment of neuropathic symptoms and signs (LANSS). Safety of the drugs was monitored by adverse drug reactions (ADRs).

Results: All patients were over 57 years and thoracic dermatome was most affected. Both drugs significantly reduced NRS and LANSS (p<0.0001). However, on comparison pregabalin was found to be better than nortriptyline at 8 weeks on mean NRS (p= 0.0073), LANSS (p=0.0032). Total of six mild ADRs occurred, two in group pregabalin and four in nortriptyline treated group.

Conclusion: Both pregabalin and nortriptyline were effective in patients of PHN, but pregabalin was found to be better than nortriptyline at 8 weeks. Both drugs were well tolerated, though pregabalin had lesser number of ADRs.

Downloads

Download data is not yet available.

Author Biography

VIJAY KHAJURIA, Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India.

ex professor , pharmacology , GMC Jammu

References

Strambi FL. Neuropathic pain and sleep. Pain Ther 2017;6:S19-23. DOI: https://doi.org/10.1007/s40122-017-0089-y

Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Prac 2009;84:274-80. DOI: https://doi.org/10.4065/84.3.274

Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia. N Engl J Med 2014;371:1526-33. DOI: https://doi.org/10.1056/NEJMcp1403062

McElveen WA, Sinclair D. Postherpetic Neuralgia Medication 2018. Available from: https://www.emedicine.medscape.com/ article/1143066-medication. [Last accessed on 2018 Oct].

O’Connor AB, Dworkin RH. Treatment of neuropathic pain. An overview of recent guidelines. Am J Med 2009;122:22-32. DOI: https://doi.org/10.1016/j.amjmed.2009.04.007

Verma V, Singh N, Jaggi AS. Pregabalin in neuropathic pain: Evidences and possible mechanisms. Curr Neuropharmacol 2014;12:44-56. DOI: https://doi.org/10.2174/1570159X1201140117162802

Achar A, Bisai S, Biswas R, Besra M, Guharay T, Ghosh T. Amitriptyline versus pregabalin in post herpetic neuralgia: A randomized clinical trial. Turk J Dermatol 2013;7:145-9. DOI: https://doi.org/10.4274/tdd.1115

Derry S, Wiffen PJ, Aldington D, Moore RA. Nortriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015;1:CD011209. DOI: https://doi.org/10.1002/14651858.CD011209.pub2

Panickar A, Serpell M. Guidelines for General Practitioners on Treatment of Pain in Post-herpetic Neuralgia. United Kingdom: The Shingles Support Society; 2015. p. 1-4.

McCaffery M, Beebe A. Pain: Clinical Manual for Nursing Practice. St. Louis, MO: Mosby; 1989.

Parsons B, Pan X, Xie L, Chen Y, Ortiz M, Whalen E. Comparison of the efficacy and safety of pregabalin for postherpetic neuralgia in Chinese and international patients. J Pain Res 2018;11:1699-708. DOI: https://doi.org/10.2147/JPR.S157856

Bennett M. The LANSS pain scale: The Leeds assessment of neuropathic symptoms and sign. Pain 2001;92:147-57. DOI: https://doi.org/10.1016/S0304-3959(00)00482-6

Jha A, Siddalingappa K, Herakal K, Malhotra K. Randomized study to compare the effect of pregabalin with fixed-drug combination of pregabalin and methylcobalamin in the patients of postherpetic neuralgia. Indian J Pain 2018;32:63-7. DOI: https://doi.org/10.4103/ijpn.ijpn_10_18

Zhang M, Gao CX, Ma KT, Li L, Dai Z, Wang S, Si JQ. A meta-analysis of therapeutic efficacy and safety of gabapentin in the treatment of postherpetic neuralgia from randomized controlled trials. Biomed Res Int 2018;2018:7474207. DOI: https://doi.org/10.1155/2018/7474207

Yin J, Pan Y, Zeng Z, Guo J, Yang J, Feng Z. Efficacy of pregabalin in the treatment of postherpetic neuralgia: A meta-analysis of randomized controlled trials. Int J Clin Exp Med 2016;9:20693-701.

Wang SL, Wang H, Nie HY, Bu G, Shen XD, Wang H. The efficacy of pregabalin for acute pain control in herpetic neuralgia patients: A meta-analysis. Medicine 2017;96:e9167. DOI: https://doi.org/10.1097/MD.0000000000009167

Gilron I, Tu D, Holden RR, Jackson AC, DuMerton-Shore D. Combination of morphine with nortriptyline for neuropathic pain. Pain 2015;156:1440-8. DOI: https://doi.org/10.1097/j.pain.0000000000000149

Obata H. Analgesic mechanisms of antidepressants for neuropathic pain. Int J Mol Sci 2017;18:2483. DOI: https://doi.org/10.3390/ijms18112483

Bohren Y, Tessier LH, Megat S, Petitjean H, Hugel S, Daniel D, et al. Antidepressants suppress neuropathic pain by a peripheral beta2- adrenoceptor mediated anti-TNFalpha mechanism. Neurobiol Dis 2013;60:39-50. DOI: https://doi.org/10.1016/j.nbd.2013.08.012

Fornasari D. Pharmacotherapy for neuropathic pain: A review. Pain Ther 2017;6:25-33. DOI: https://doi.org/10.1007/s40122-017-0091-4

Sabatowskia R, Galvezb R, Cherryc DA, Jacquotd F, Vincentd E, Maisonobed P, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: Results of a randomized, placebo-controlled clinical trial. Pain 2004;109:26-35. DOI: https://doi.org/10.1016/j.pain.2004.01.001

Chandra K, Shafiq N, Pandhi P, Gupta S, Malhotra S. Gabapentin versus nortriptyline in post-herpetic neuralgia patients: A randomized, double-blind clinical trial-the GONIP trial. Int J Clin Pharmacol Ther 2006;44:358-63. DOI: https://doi.org/10.5414/CPP44358

Liu Q, Chen H, Xi L, Hong Z, He L, Fu Y, et al. A randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of pregabalin for postherpetic neuralgia in a population of Chinese patients. Pain Pract 2017;17:62-9. DOI: https://doi.org/10.1111/papr.12413

Atkinson JH, Slater MA, Williams RA, Zisook S, Patterson TL, Grant I, et al. A placebo-controlled randomized clinical trial of nortriptyline for chronic low back pain. Pain 1998;76:287-96. DOI: https://doi.org/10.1016/S0304-3959(98)00064-5

Watson CP, Vernich L, Chipman M, Reed K. Nortriptyline versus amitriptyline in postherpetic neuralgia: A randomized trial. Neurology 1998;51:1166-71. DOI: https://doi.org/10.1212/WNL.51.4.1166

Bansal D, Bhansali A, Hota D, Chakrabarti A, Dutta P. Amitriptyline vs. Pregabalin in painful diabetic neuropathy: A randomized double blind clinical trial. Diabet Med 2009;26:1019-26. DOI: https://doi.org/10.1111/j.1464-5491.2009.02806.x