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Comparative Study of Clinical Efficacy of Amitriptyline and Pregabalin in Postherpetic Neuralgia
Arun Achar
; Department of Dermatology Vidyasagar University Midnapore-721 102 West Bengal, India
Partha Pratim Chakraborty
; Department of Medicine, Midnapore Medical College Paschim Medinipur, West Bengal;
Samiran Bisai
; Department of Anthropology Vidyasagar University Midnapore-721 102 West Bengal, India
Asish Biswas
; Department of Pharmacology, N.R.S. Medical College, Kolkata,West Bengal
Tapobrata Guharay
; Department of Community Medicine, Midnapore Medical College, Paschim Medinipur, West Bengal, India
Abstract
The most common complication of herpes zoster in immunocompetent
patients is postherpetic neuralgia, which is very difficult to treat. Significant
beneficial effects have been found for amitriptyline, gabapentin, pregabalin,
carbamazepine, sodium valproate, oxycodone, corticosteroid, topical capsaicin,
tramadol, etc. The aim of this open randomized comparative study was to demonstrate
clinical efficacy of amitriptyline and pregabalin. The study included 50
patients, 32 (64%) male and 18 (36%) female, randomized to receive either amitriptyline
or pregabalin (n=25 each). Amitriptyline was administered in a dose of
25 mg once daily and pregabalin in a dose of 75 mg twice daily. Inclusion criteria
were as follows: postherpetic neuralgia of more than 1 month duration; pain of
at least moderate severity; and patient age 40 years or older and no pregnancy.
Patients with a history of any serious diseases (renal, cardiac, hepatic or seizure)
were excluded. Total treatment period spanned 8 weeks, with patient follow up
visits at 2, 4 and 8 weeks to assess the degree of improvement in pain perception
and any adverse reaction. Patients with four herpes zoster types were included in
this study, of which thoracic type predominated (54%). Other types were cervical
in 12 (24%), trigeminal in 8 (16%) and lumbosacral in 3 (6%) patients. Prodromal
symptoms before herpes zoster were reported by 66% of study patients. Satisfactory
improvements of pain perception at the end of 8 weeks (>75%) were noticed
in pregabalin group, which was statistically significant (χ2=10.08; P<0.05).
Dry mouth was the commonest complication in amitriptyline group and dizziness
in pregabalin group. More importantly, none of the patients stopped treatment
due to adverse reaction. In conclusion, therapy with pregabalin is better
compared to amitriptyline in postherpetic neuralgia patients. However, a similar
study in a larger sample is required to validate the present findings.
Keywords
amitriptyline; herpes zoster; pregabalin; postherpetic neuralgia
Hrčak ID:
89096
URI
Publication date:
21.6.2012.
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