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Combination Gabapentin Plus Valacyclovir May Diminish Risk of Post-Herpetic Neuralgia: Presented at AAD

By Pamela Harrison

Special to DG News

NEW ORLEANS, LA -- February 26, 2002 -- The combination of the anticonvulsant gabapentin, the antiviral valacyclovir appears to diminishes greatly the risk of post-herpetic neuralgia following an acute herpes zoster outbreak compared with antiviral therapy alone.

Results from a study which compared valacyclovir plus gabapentin against antiviral monotherapy were presented here today during a poster session at the 60^th annual meeting of the American Academy of Dermatology.

Dr. M.H. Brentjens and colleagues from the departments of dermatology, microbiology, immunology and medicine, at University of Texas Medical Branch, in Galveston, Texas, treated 30 patients who were at least 50 years of age with concomitant gabapentin 300 mg a day plus valacyclovir 1 g three times a day, for seven days. Treatment was initiated within 72 hours of vesicle or papule formation.

If patients tolerated the initial dose of gabapentin, it was increased to three times a day dosing on the eighth day of therapy, and the dose was subsequently titrated up on a weekly basis to a maximum dose of 1200 mg, three times a day on day 29, after which the dose was maintained for 28 more days.

"Patients had a pain score measured on an 11-point Likert scale of at least 4 [at baseline]," the authors indicated, "and the primary end point of the study was time to cessation of zoster pain and the presence of zoster pain at 12 and 24 weeks."

From the initial clinic visit, the average pain intensity score dropped from 7.63 to 2.12 at week 4, to 0.96 at week 12, to 0.21 at week 24. "The maximum pain score at week 12 was 5 and the maximum pain score at week 24 was 2," according to the researchers. By week 12, only three patients rated their pain as moderate to severe, while no patient rated their pain as moderate or severe at week 24.

Equally important, the incidence of post-herpetic neuralgia (PHN) at three and six months was markedly lower than what is generally reported from historical controls. In the current study, 46 percent of patients had on-going pain at three months, while 16 percent had on-going pain at six months. This compared with 65 percent and 40 percent for historical controls at three and six months, respectively.

Side effects included somnolence, dizziness, dry mouth and nausea, but generally speaking, gabapentin was well tolerated. The authors found, however, that side effects became more limiting at lower doses than has been found in other studies of gabapentin.

"Our data indicate that combination therapy with valacyclovir and gabapentin may be more effective in reducing the duration of PHN when compared with historical controls receiving only antiviral therapy alone," the authors concluded.

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