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Two-Drug Combo Appears Better Than Monotherapy for Neuropathic Pain
A combination of the anticonvulsant gabapentin and the antidepressant nortriptyline relieves neuropathic pain more effectively than either drug alone, Lancet reports.
In a crossover study, 56 adults with chronic pain due to diabetic polyneuropathy or postherpetic neuralgia were assigned to the following treatment regimens: gabapentin alone, nortriptyline alone, and a combination of the two. All patients were to receive each regimen, for 6 weeks each, but the sequence of the regimens was randomized. Drug doses were titrated to the maximal tolerable dose.
Overall, mean daily pain intensity was significantly lower with combination therapy than with monotherapy. Adverse events were similar with the three treatments, although significantly fewer patients reported dry mouth with gabapentin than with the other regimens.
The authors discuss several study limitations but conclude: "We recommend combined gabapentin and nortriptyline for patients who have a partial response to either drug alone and seek additional pain relief."
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Published in Physician's First Watch September 30, 2009
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