Effect of duloxetine on neuropathic pain in patients intolerant to continuous administration of pregabalin

Abstract

Abstract:Purpose: We examined duloxetine's effectiveness in the treatment of neuropathic pain in patients who were intolerant to continuous pregabalin administration. Materials and Methods: The present study is a retrospective study of patients diagnosed with neuropathic pain with neuropathic leg pain as the chief complaint. We analyzed 20 cases in which pregabalin was changed to duloxetine because of adverse effects (16 cases) or treatment failure (4 cases). The incidence of adverse events after duloxetine administration was used as the primary endpoint, with the secondary endpoint being the leg pain level based on a numerical rating scale (NRS). Results: The incidence of adverse events after starting duloxetine was 40%. Average leg pain scores measured on the NRS were 8.4 1.4, 6.4 1.4, and 4.1 2.0 at the time of the patients' first visit, pregabalin discontinuation, and after switching to duloxetine, respectively. A significant difference in NRS scores was found between the first visit and pregabalin discontinuation and also between pregabalin discontinuation and after the switch to duloxetine (p<0.05), indicating that pain decreases over time. Furthermore, NRS scores significantly declined between the patients' first visit and after the switch to duloxetine (p<0.05). The improvement in NRS score was 20 12.8% after pregabalin administration and 23 12.0% after duloxetine administration compared with baseline scores (no significant difference between pregabalin and duloxetine; p>0.05). Conclusion: When patients with neuropathic pain are unable to tolerate pregabalin because of adverse effects, changing the medication to duloxetine may be an option.

Switching From Pregabalin to Mirogabalin in Patients with Peripheral Neuropathic Pain: A Multi-Center, Prospective, Single-Arm, Open-Label Study (MIROP Study)

“…These AEs can significantly lower compliance, sometimes leading to discontinuation before a therapeutic effect can be achieved. In patients in whom insufficient efficacy is observed with pregabalin, switching to other agents has been studied, and a reduction in AEs and an improvement in pain relief have been reported [12]. Thus, when considering a switch from pregabalin to mirogabalin, safety is an important consideration; however, there are insufficient safety data available in this setting.…”

Clinical Outcomes of Mirogabalin Treatment for Neuropathic Pain Due to Spinal Diseases in Patients Intolerant to Continuous Administration of Pregabalin

“…A Cochrane review of pregabalin reported that the withdrawal rate due to AEs was 3.6%-19% and that due to all causes was 12%-26% when pregabalin was administered at a dose of 600 mg daily 3) . There have been a few reports of PNeP treatment wherein pregabalin could not be administered continuously [4][5][6] , and it remains unclear which drug should be administered following this discontinuation.…”