Lamotrigine for HIV-associated painful sensory neuropathies

Simpson, David M.; McArthur, Justin C.; Olney, Richard K.; Clifford, David B.; So, Yuen T.; Ross, David Gaddis; Baird, Becky; Barrett, Pamela S.; Hammer, Anne E.; Baker, R. D.; Bartt, Russell; Becker, Susanne; Berger, Joseph R.; Brannagan, Thomas H.; Cohen, Bruce A.; Dorko, Craig; Ellis, Rachel; Feinberg, D. M.; Goodkin, Karl; Hall, C.; Kumar, P.; Marra, Christina M.; Pollard, Richard B.; Schifitto, Giovanni; Tselis, Alex; Vollmer, Kathrin

doi:10.1212/01.wnl.0000063304.88470.d9

Cited by 223 publications

(91 citation statements)

References 26 publications

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“…However, a notable randomized, double-blind, placebo-controlled eight-week study in patients with various neuropathic pain syndromes at doses of 200 mg/day showed no significant benefit for lamotrigine. [115][116][117][118][119][120] …”

Section: Lamotriginementioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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Summary: Antiepileptic drugs (AEDs) are commonly utilized for nonepileptic conditions, including various psychiatric disorders and pain syndromes. Evidence for their benefit in these nonepileptic conditions varies widely among different drugs, but there is, in general, a paucity of published multicenter randomized double-blind trials. Variable levels of evidence suggest that lamotrigine and the vagal nerve stimulator have antidepressant properties. Carbamazepine, valproate, lamotrigine, and oxcarbazepine appear to have mood stabilizing properties while gabapentin, pregabalin, and tiagabine have anxiolytic benefits. Barbiturates, topiramate, and possibly phenytoin may precipitate or exacerbate depression. Underlying depression and anxiety symptoms may be exacerbated by levetiracetam, while psychotic symptoms have rarely been reported with topiramate, levetiracetam, and zonisamide. Pregabalin, gabapentin, carbamazepine, and oxcarbazepine have been used to treat neuropathic pain such as postherpetic neuralgia, and diabetic polyneuropathy. Topiramate and divalproex sodium have utility in the prophylaxis or acute treatment of migraine. Further rigorous studies are needed to clarify the utility of AEDs in nonepileptic conditions.

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Section: Lamotriginementioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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“…However, a subsequent randomized controlled trial that tested this higher dose in HIV neuropathy patients was negative. 32 Moreover, the high rate of discontinuation of therapy in this study (higher in the lamotrigine arm when compared with placebo) would indicate that a higher dose would be less well tolerated. Therefore, it appears unlikely that the lack of efficacy noted in this study can be attributed to suboptimal dosing.…”

Section: Discussionmentioning

confidence: 83%

Efficacy of lamotrigine in the management of chemotherapy‐induced peripheral neuropathy

Rao

Flynn

Sloan

et al. 2008

Cancer

165

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BACKGROUND.Lamotrigine, an antiepileptic agent, has been reported as being effective in reducing symptoms of neuropathy associated with various etiologies. Based on such data, a multicenter double‐blind, placebo‐controlled, randomized trial was conducted to evaluate the effect of lamotrigine on pain and other neuropathic symptoms due to chemotherapy‐induced peripheral neuropathy (CIPN).METHODS.Patients with symptomatic CIPN with symptom scores of either 1) >3 on a 0‐10 Numerical Rating Scale (NRS) or 2) >1 on the 0‐3 the Eastern Cooperative Oncology Group (ECOG) neuropathy scale (ENS) were eligible (higher numbers corresponding to greater severity of symptoms in both scales). Patients were randomly assigned to receive lamotrigine (target dose of 300 mg/day) or placebo for 10 weeks. Endpoints were measured biweekly.RESULTS.In all, 131 patients were enrolled. Both groups were well matched at baseline. Over the 10‐week period of the trial, the average pain scores (NRS) for the lamotrigine and placebo arms declined in both arms, with no statistically significant difference noted between the changes in the 2 groups (0.3 and 0.5 unit reduction from baseline, respectively; P = .56). Similarly, decreases in the ENS with therapy were not statistically different (0.4 and 0.3, respectively; P = .3). Changes in other subjective symptom scales were also not found to be statistically different between the 2 groups. Toxicities were mild and similar in each group.CONCLUSIONS.The results suggest that lamotrigine is not effective for relieving neuropathic symptoms in patients because of CIPN. Cancer 2008. © 2008 American Cancer Society.

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“…27 A single high-concentration capsaicin patches has shown sustained 12 weeks of pain reduction in HIV-associated polyneuropathy. 28 Randomized controlled trials have demonstrated positive results for cannabis smoking, however, administration of cannabis smoking for a long term has high addictive potential and associated health risk.…”

Section: Hiv Associated Polyneuropathymentioning

confidence: 99%

Evidence-based pharmacological management of chronic neuropathic pain

Ansari

2013

Int J Basic Clin Pharmacol

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Neuropathic pain (NP) is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP), post-herpetic neuralgia (PHN), trigeminal neuralgia, HIV-associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline), selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine), calcium channel alpha 2 -delta ligands (pregabalin, gabapentin), carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient's age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and improving the cognitive and emotional well-being.

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Lamotrigine for HIV-associated painful sensory neuropathies

Cited by 223 publications

References 26 publications

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

Efficacy of lamotrigine in the management of chemotherapy‐induced peripheral neuropathy

Evidence-based pharmacological management of chronic neuropathic pain

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