Anticonvulsants and Antiarrhythmics
53. What other alternatives are there for the management of L.K.'s neuropathic pain?
Anticonvulsants have been used frequently in the management of neuropathic pain with varying success. In randomized-controlled studies, gabapentin and pregabalin have improved symptoms of diabetic neuropathy and postherpetic neuralgia.177,178 Doses of gabapentin up to 3,600 mg/day or greater may be required in some patients, whereas the range for pregabalin is from 150 to 600 mg/day. Additionally, higher doses of gabapentin are generally well tolerated compared with pregabalin. Gabapentin requires more individualization in patients because doses are slowly titrated to pain control. Pregabalin can be titrated more rapidly and has a short onset of action (<1 week), which may require less combination therapy in some patients. The most common side effects of gabapentin and pregabalin include dizziness, somnolence, peripheral edema, and dry mouth.176,179
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