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Lamotrigine Effective in Refractory Neuropathic Pain: Presented at WCP

By Peggy Peck
Special to DG News

SAN DIEGO, CA -- August 21, 2002 -- Lamotrigine appears to be an effective third line treatment for refractory trigeminal neuralgia and peripheral neuropathy, but is not effective for treatment of radiculopathy.

These results, from a chart review of patients who received lamotrigine as third line therapy for refractory neuropathic pain, were presented August 20^th at the 10^th World Congress on Pain.

M. Gabriela Gregory, MD of Nevada Neurological Consultants, Las Vegas, Nevada, and Marilyn R. Semenchuck, PharmD of GlaxoSmithKline, Tuscon, Arizona, United States, reviewed charts from 33 men and 47 women mean age 60. Twenty-eight had peripheral neuropathy, 18 trigeminal neuralgia, 11 radiculopathy, five had diabetic neuropathy, four had postherpetic neuralgia, four central pain, three atypical head pain, two failed back pain syndrome, and five had other diagnoses.

All patients had failed at least two or more attempts at treatments with other medications including gabapentine, tricyclic antidepressants, narcotics, carbamazepine, oxcarbazepine, tiagabine, topiramate and baclofen.

Patients were started on lamotrigine at a dose of 50 mg/day for two weeks, increased to 100 mg/day for two weeks and titrated upward by 50 mg/day at weekly intervals. The target dose was 200 mg/day. Maximum dose prescribed was 600 mg/day.

Of 68 evaluable patients 38 percent responded to lamotrigine. Lamotrigine was most effective in patients with diabetic neuropathy, followed by postherpetic neuralgia, trigeminal neuralgia, peripheral neuropathy and central pain. Most patients with radiculopathy were non-responders as were patients with atypical head pain and failed back syndrome.

The average dose of lamotrigine in responders was 300 mg/day while the average dose in non-responders was 160 mg/day. Four patients discontinued due to side effects.

The study was funded by GlaxoSmithKline.

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