Neurontin in the Management of pain

Neurontin is currently indicated as an adjunctive therapy in the treatment of partial onset seizures in adults.

There are recent reports indicating that Neurontin may be helpful for treatment of certain types of pain.

Reflex Sympathetic Dystrophy

Mellick et. al.

Nine patients treated with Neurontin
Doses ranged from 900 to 2400 mg per day
Eight patients reported excellent pain relief
One with good relief
It took from two hours to twelve days for pain relief to occur

Neuropathic & Myofascial Pain

Rosenberg et al

Retrospective review of 122 patients
Received Gabapentin for pain for at least 30 days
Statistically significant decrease in the pain scores
No significant difference for the low back pain group
Post herpetic neuralgia group has the greatest decrease in pain score.

Migraine headaches

Nicoldi and Sicutari

17 patients: partially or totally refractory to conventional migraine treatment
Gabapentin 400 to 1200 mg per day for one month
Statistically significant relief of headache as compared to baseline and washout period.

Pharmacology:

Initially developed as an anticonvulsant agent
May facilitate GABA release
Excreted by the kidneys without undergoing hepatic metabolism
Less than 3% plasma protein binding
Minimal drug interactions
Good blood/brain barrier penetration
No major adverse hepatic effect

Main side effects:

Dizziness, somnolence, ataxia and nystagmus
Usually does related, usually subside with continued use

Dosing:

Available in 100, 300, and 400 mg tablets
Starting dose: 300 mg at bedtime
Gradually increase to 300 mg 2-3 time a day
Maximum dose is probably around 2400 mg per day
Some neurologists have used it up to 3600 mg per day

Further reading

References:

Mellick, G.A. and Lias: Gabapentin In The Management Of Reflex Sympathetic Dystrophy. Letter, Journal Of Pain Symptomatic Management, 1995: 10: 265-266.

Mellick, G.A. and Lias: Gabapentin In The Management Of Reflex Sympathetic Dystrophy. Journal Of Pain and Symptomatic Management, 1995: 10: 265-266.

Resenberg JM et al. The effect of Gabapentin on Neuropathic Pain. Clin J. Pain 1997;13:251-255

Nicoldi M et al. A NMDA Modulator, Gabapentin (Neurontin), Clearly facilitates Resolution of Chronic Migraine. Pharmacol. Res. 1997;35(supp):64.

Mathew, N.T. and Lias: Gabapentin In Migraine Prophylaxis: A Preliminary Open Labeled Study. Neurology 1996; 46: A169.

Dejong, R.H.: Neurontin: Pie In The Sky Or Pie On The Plate ? Pain Digest 1996: 6: 143-144.

Drug Package Insert, Neurontin, Gabapentin Capsules, Parke- Davis Pharmaceutical, Morris Plains, New Jersey, 1994.