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Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials.
Clin Ther 2003; 25(1):81-104CT

Abstract

BACKGROUND

Pain is one of the most common reasons for seeking medical attention, and neuropathic pain is among the most common types of pain. Despite its prevalence, neuropathic pain is often underrecognized and inadequately treated. Many cases are refractory to the medications traditionally used for pain, such as nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants are considered first-line agents for neuropathic pain, but their use is limited by unwanted side effects and a risk of cardiovascular mortality.

OBJECTIVES

The goals of this article were to review data on the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in adults and to determine the optimal dosing schedule.

METHODS

Randomized controlled studies of gabapentin for neuropathic pain were identified through a search of PubMed and MEDLINE from 1966 to the present using the search terms gabapentin, randomized, placebo, and pain. Abstracts of identified articles were screened for study size (>100 patients per treatment arm) and use of appropriate efficacy measures. A separate review based on information provided by the manufacturer of gabapentinaand clinical trial Web sites was conducted to ascertain whether there had been any other relevant industry- or government-sponsored trials. The manufacturer provided additional unpublshed study data.

RESULTS

Data from 5 randomized, placebo-controlled trials were included in the review, 1 of which has not yet been published. Gabapentin was effective in the treatment of painful diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain syndromes. It relieved symptoms of allodynia, burning pain, shooting pain, and hyperesthesia. Adverse effects were typically mild to moderate and usually subsided within approximately 10 days from the initiation of treatment. Based on available data, it appears that treatment should be started at a dose of 900 mg/d (300 mg/d on day 1, 600 mg/d on day 2, and 900 mg/d on day 3). Additional titration to 1800 mg/d is recommended for greater efficacy. Doses up to 3600 mg/d may be needed in some patients. The effective dose should be individualized according to patient response and tolerability.

CONCLUSION

At doses of 1800 to 3600 mg/d, gabapentin was effective and well tolerated in the treatment of adults with neuropathic pain.

Authors+Show Affiliations

Department of Neurology, Anesthesiology, and Rehabilitation Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin 53792, USA. backonja@neurology.wisc.eduNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12637113

Citation

Backonja, Miroslav, and Robert L. Glanzman. "Gabapentin Dosing for Neuropathic Pain: Evidence From Randomized, Placebo-controlled Clinical Trials." Clinical Therapeutics, vol. 25, no. 1, 2003, pp. 81-104.
Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther. 2003;25(1):81-104.
Backonja, M., & Glanzman, R. L. (2003). Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clinical Therapeutics, 25(1), pp. 81-104.
Backonja M, Glanzman RL. Gabapentin Dosing for Neuropathic Pain: Evidence From Randomized, Placebo-controlled Clinical Trials. Clin Ther. 2003;25(1):81-104. PubMed PMID: 12637113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. AU - Backonja,Miroslav, AU - Glanzman,Robert L, PY - 2003/3/15/pubmed PY - 2003/5/20/medline PY - 2003/3/15/entrez SP - 81 EP - 104 JF - Clinical therapeutics JO - Clin Ther VL - 25 IS - 1 N2 - BACKGROUND: Pain is one of the most common reasons for seeking medical attention, and neuropathic pain is among the most common types of pain. Despite its prevalence, neuropathic pain is often underrecognized and inadequately treated. Many cases are refractory to the medications traditionally used for pain, such as nonsteroidal anti-inflammatory drugs. Tricyclic antidepressants are considered first-line agents for neuropathic pain, but their use is limited by unwanted side effects and a risk of cardiovascular mortality. OBJECTIVES: The goals of this article were to review data on the efficacy and tolerability of gabapentin in the treatment of neuropathic pain in adults and to determine the optimal dosing schedule. METHODS: Randomized controlled studies of gabapentin for neuropathic pain were identified through a search of PubMed and MEDLINE from 1966 to the present using the search terms gabapentin, randomized, placebo, and pain. Abstracts of identified articles were screened for study size (>100 patients per treatment arm) and use of appropriate efficacy measures. A separate review based on information provided by the manufacturer of gabapentinaand clinical trial Web sites was conducted to ascertain whether there had been any other relevant industry- or government-sponsored trials. The manufacturer provided additional unpublshed study data. RESULTS: Data from 5 randomized, placebo-controlled trials were included in the review, 1 of which has not yet been published. Gabapentin was effective in the treatment of painful diabetic neuropathy, postherpetic neuralgia, and other neuropathic pain syndromes. It relieved symptoms of allodynia, burning pain, shooting pain, and hyperesthesia. Adverse effects were typically mild to moderate and usually subsided within approximately 10 days from the initiation of treatment. Based on available data, it appears that treatment should be started at a dose of 900 mg/d (300 mg/d on day 1, 600 mg/d on day 2, and 900 mg/d on day 3). Additional titration to 1800 mg/d is recommended for greater efficacy. Doses up to 3600 mg/d may be needed in some patients. The effective dose should be individualized according to patient response and tolerability. CONCLUSION: At doses of 1800 to 3600 mg/d, gabapentin was effective and well tolerated in the treatment of adults with neuropathic pain. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/12637113/Gabapentin_dosing_for_neuropathic_pain:_evidence_from_randomized_placebo_controlled_clinical_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149291803900117 DB - PRIME DP - Unbound Medicine ER -