WESTPORT, CT (Reuters Health) Nov 20 - For patients with painful diabetic neuropathy, gabapentin provides greater pain relief and reduction in paresthesia than amitriptyline without causing as many adverse effects.
Recent research has demonstrated the effectiveness and safety of gabapentin for the treatment of painful diabetic neuropathy, but no previous studies have been published that compared the drug with tricyclic antidepressants, the first-line therapy for the condition.
In the October issue of the Journal of Pain and Symptom Management, Dr. Paolo Mazzarello and colleagues, from S. Giacomo Hospital in Novi Ligure, Italy, report on an open-label trial in which they compared gabapentin with amitriptyline in elderly patients with painful diabetic neuropathy.
In the 12-week trial, 13 patients were randomized to receive gabapentin and 12 were treated with amitriptyline. The gabapentin dose began at 400 mg/day and was titrated up to 2400 mg/day over 4 weeks, while amitriptyline began at 10 mg/day and was titrated up to 90 mg/day. Patients were not allowed to use other analgesics during the study.
A similar number of patients in each group achieved a pain score of one or less, but in three patients taking gabapentin pain was completely eliminated. None of those taking amitriptyline achieved this level of pain reduction.
While nine patients in the gabapentin group achieved a paresthesia score of one or less, the same was true for just four in the amitriptyline group. Two patients taking gabapentin achieved a score of zero, a reduction not achieved by any individuals in the amitriptyline group.
Adverse effects were less common in the gabapentin group than in the amitriptyline group, occurring in four and 11 patients, respectively.
The authors acknowledge that other tricyclic antidepressants might fare better than amitriptyline in comparison with gabapentin. But they conclude that clinical experience with the drug and the current results "suggest that gabapentin is a well-tolerated treatment for painful diabetic neuropathy, and perhaps it should be considered as a first-line therapy for this condition."
J Pain Symptom Manage 2000;20:280-285.
Copyright © 2000 Reuters Ltd.