Premedication With Gabapentin Significantly Reduces the Risk of Postherpetic Neuralgia in Patients With Neuropathy

Ghanavatian, Shirin; Wie, Christopher; Low, Rhonda S.; Zhang, Nan; Montoya, Jordan; Dhaliwal, Gurman Singh; Swanson, David L.

doi:10.1016/j.mayocp.2018.11.004

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Many patients benefit from using baclofen as a muscle relaxant or for several off-label indications including alcoholism, gastroesophageal reflux disease, nystagmus, and trigeminal neuralgia . This study was not designed to answer the question of whether the potential benefits of baclofen outweigh its risks, and clinicians will need to judge this on a patient-by-patient basis.…”

Section: Discussionmentioning

confidence: 99%

“…Baclofen is a centrally acting γ-amino butyric acid agonist that was prescribed more than 8.3 million times in the United States in 2016 . It is primarily used as a muscle relaxant for patients with spasticity, but it is also prescribed off-label for alcoholism, gastroesophageal reflux disease, nystagmus, and trigeminal neuralgia . Unlike other muscle relaxants that are primarily metabolized by the liver, baclofen is eliminated primarily unchanged in the urine, with a step-wise prolongation in the elimination half-life as kidney function declines .…”

Section: Introductionmentioning

confidence: 99%

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Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease

Muanda

Weir

Bathini

et al. 2019

JAMA

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IMPORTANCE At least 30 case reports have linked the muscle relaxant baclofen to encephalopathy in patients with chronic kidney disease (CKD). OBJECTIVE To compare the 30-day risk of encephalopathy in patients with CKD and newly prescribed baclofen at greater than or equal to 20 mg per day vs less than 20 mg per day. The secondary objective was to compare the risk of encephalopathy in baclofen users vs nonusers. DESIGN, SETTING, AND PARTICIPANTS Retrospective population-based cohort study in Ontario, Canada (2007-2018) using linked health care data. Participants comprised 15 942 older adults (aged 66 years or older) with CKD (defined as an estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m 2 but not receiving dialysis). The primary cohort was restricted to patients who were newly prescribed baclofen; participants in the secondary cohort were new users and nonusers. EXPOSURES Prescription for oral baclofen greater than or equal to 20 mg per day vs less than 20 mg per day. MAIN OUTCOMES AND MEASURES Hospital admission with encephalopathy, defined as a main diagnosis of delirium, disorientation, transient alteration of awareness, transient cerebral ischemic attack, or unspecified dementia within 30 days of starting baclofen. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on indicators of baseline health. Weighted risk ratios (RRs) were obtained using modified Poisson regression and weighted risk differences (RDs) using binomial regression. Prespecified subgroup analyses were conducted by eGFR category. RESULTS The primary cohort comprised 15 942 patients with CKD (9699 [61%] women; median age, 77 years [interquartile range, 71-82]; 9707 [61%] patients started baclofen at Ն20 mg/d and 6235 [39%] at <20 mg/d). The primary outcome, hospitalization with encephalopathy, occurred in 108/9707 (1.11%) patients who started baclofen at greater than or equal to 20 mg per day and in 26/6235 (0.42%) who started baclofen at less than 20 mg per day; weighted RR, 3.54 (95% CI, 2.24 to 5.59); weighted RD, 0.80% (95% CI, 0.55% to 1.04%). In subgroup analysis, the absolute risk increased progressively at lower eGFR (weighted RD eGFR 45-59, 0.42% [95% CI, 0.19%-0.64%]; eGFR 30-44, 1.23% [95% CI, 0.62%-1.84%]; eGFR <30, 2.90% [95% CI, 1.30%-4.49%]; P for interaction, <.001]). In the secondary comparison with 284 263 nonusers, both groups of baclofen users had a higher risk of encephalopathy (<20 mg/d weighted RR, 5.90 [95% CI, 3.59 to 9.70] and Ն20 mg/d weighted RR, 19.8 [95% CI, 14.0 to 28.0]). CONCLUSIONS AND RELEVANCE Among older patients with CKD who were newly prescribed baclofen, the 30-day incidence of encephalopathy was increased among those prescribed higher doses compared with lower doses. If verified, these risks should be balanced against the benefits of baclofen use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease

Muanda

Weir

Bathini

et al. 2019

JAMA

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“…Early treatment of pain with pregabalin or gabapentin may be effective in reducing the risk of PHN [103,104].…”

Section: Preventionmentioning

confidence: 99%

An analysis and visualization of postherpetic neuralgia research between 1985 and 2022 using scientometrics

Cao

Zhang

et al. 2023

Preprint

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Background This study aimed to highlight the status of research on PHN between 1985 and 2022 through a bibliometric analysis and a historical review. Methods The Web of Science database was searched, and 3,386 relevant articles were included in the study. Bibliometric analysis was used to review the field distribution, regional distribution, and research topic evolution. Results Trends identified in the literature indicate that research on PHN is increasing globally. The United States is the leading country, and the University of California system is the leading institution in terms of publications. Glaxosmithkline had the highest number of citation bursts, indicating its important role in PHN research and drug development. PHN is primarily associated with older age and immunosuppression. Treatment mainly involves pharmacological, nonpharmacological, and interventional treatments, although data supporting the use of physical interventions are lacking. The main psychophysiological effects experienced by patients with PHN are anxiety, insomnia, and depression. Additionally, PHN results in a significant economic burden. Two vaccines have been approved for herpes zoster. Finally, animal models of PHN are inadequate. Conclusions The findings of this study provide valuable information for future research on PHN, e.g., research is needed on the mechanism of PHN, the development of suitable animal models, and the long-term effects of interventional treatment.

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“…The voltage-gated calcium channel blocker gabapentin is recommended as the first-line medication [7] for PHN and has been extensively applied in clinical practice. In a recent retrospective study [17], premedication with gabapentin administered for other peripheral neuropathies, including neuropathy caused by diabetes, adverse drug effects, radiotherapy and other diseases, before acute HZ onset was found to assist in the prevention of PHN. A similar outcome was observed in an uncontrolled open-label study [18].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Effect of duloxetine premedication for postherpetic neuralgia within 72 h of herpes zoster reactivation [PROCESS]: a study protocol for a randomized controlled trial

Chen

Shrestha

Zhao

et al. 2020

Trials

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Background Postherpetic neuralgia (PHN) is the most common complication attributed to herpes zoster, which involves the reactivation of residual varicella zoster virus. It has been reported previously that pre-emptive amitriptyline following acute herpes zoster has shown latent positive effects in the prevention of PHN. In this study, by interfering with the same targets, norepinephrine and serotonin, we aim to evaluate whether pre-emptive duloxetine may proactively prevent PHN development. Methods This is a nationwide multicentric, randomized, open-label, blinded-endpoint study that will recruit 750 participants from 18 primary centres in China. Patients aged more than 50 years who are diagnosed with uncomplicated HZ, present with vesicles within 72 h of their emergence, and have an average pain score of at least 40/100 mm on a visual analogue scale (VAS, 0 mm = no pain, 100 mm = worst possible pain, at opposite ends of a 100-mm line) will be recruited for this study. Participants will be randomized into a duloxetine arm and a control arm. Participants allocated to the duloxetine arm will be given antivirals, analgesics and duloxetine, while those allocated to the control arm will receive antivirals and analgesics but no duloxetine. The primary outcome of this study is preventive efficacy against PHN, which will be evaluated based on a 100 mm VAS. Any pain scores other than 0 mm on the VAS 12 weeks after HZ onset will be defined as PHN. The secondary outcomes will consist of the average weekly VAS score, the average weekly consumption of each analgesic, weekly feature of the pain, patients’ quality of life based on the 12-item Short-Form Health Survey, Patient Global Impression of Change Scale, sleep quality as evaluated by the Pittsburgh Sleep Quality Index and adverse events during the study period. Discussion This study will investigate a prophylactic approach for reducing the prevalence of postherpetic neuralgia with duloxetine and will add significant new knowledge on the preventive effects of duloxetine on PHN. Trial registration Clinicaltrials.gov NCT04313335. Registered on 18 March 2020.

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Premedication With Gabapentin Significantly Reduces the Risk of Postherpetic Neuralgia in Patients With Neuropathy

Cited by 8 publications

References 15 publications

Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease

Association of Baclofen With Encephalopathy in Patients With Chronic Kidney Disease

An analysis and visualization of postherpetic neuralgia research between 1985 and 2022 using scientometrics

Effect of duloxetine premedication for postherpetic neuralgia within 72 h of herpes zoster reactivation [PROCESS]: a study protocol for a randomized controlled trial

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