NEW YORK (Reuters Health) Feb 08 - The anti-epileptic drug topiramate may be an effective addition to the arsenal of agents used to treat neuropathic and sympathetically maintained pain, researchers in Oklahoma report.
Dr. Michael G. Jenson and associates, of the Pain Evaluation and Treatment Center in Tulsa, treated 61 patients with topiramate. Patient conditions included reflex sympathetic dystrophy, migraine and cluster headaches, radiculopathy, discogenic disease, phantom limb pain, and pain resulting from skin graft and third-degree burns, in addition to diabetic and other types of neuropathies.
Dosing was initiated at 25 mg at bedtime. As the investigators report in the American Journal of Pain Management for January, they titrated doses upward at weekly intervals until efficacy was demonstrated or to a maximum of 400 mg/day.
More than half of the patients had a greater than 50% improvement in symptoms. A greater than 70% reduction in symptoms was experienced by 14.6%. Only 12.2% experienced a poor response.
The lowest dose at which patients experienced relief was 50 mg, while seven patients were titrated up to 400 mg. A mean of 131 mg was the average effective dose. Two patients discontinued use of the drug because of nausea, and another 16 because of dizziness and sedation.
Dr. Jenson and his colleagues note that the 15- and 25-mg dosage forms make topiramate easy to titrate, which enhances tolerability.
Am J Pain Manage 2002;12:16-23.
© 2002 Reuters Ltd