대상포진 후 통증에서 가바펜틴과 프레가발린, Gabapentin and pregabalin in postherpetic neuralgia

 

대상포진 후 통증에서 프레가발린을 주로 사용해 왔습니다.

아마도 당뇨병성 신경병증에 대한 치료제로 프레가발린을 사용해 온 경향 때문인 것 같습니다.

 

대상포진 후 통증에서 사용되는 몇 가지 항경련제가 있는데 찌르는듯한 통증을 줄이는데 효과가 있습니다. 무작위 연구에 평가된 약물로는 가바펜틴, 프레가발린, valproic acid가 있습니다.

 

가바펜틴, 프레가발린 두 약제 모두 신장애가 있는 경우에는 용량 조절을 해야 하며, 프레가발린을 150 mg 용량으로 바로 시작하면 어지러움을 호소하는 경우가 더러 있어서 25 mg, 50 mg, 75 mg을 적절하게 사용합니다. 프레가발린 고용량을 사용 중이었고 중단을 고려한다면 tapering합니다.

 

Gabapentin — There is moderate-quality evidence supporting the efficacy of gabapentin for PHN, but not all trials have shown a statistically significant benefit, particularly for the extended-release formulation of gabapentin, and outcomes are not well studied beyond 12 weeks.

 

Gabapentin is typically started at a low dose and titrated to effect. Our suggested gabapentin regimen for PHN is 300 mg on day 1, 300 mg twice daily on day 2, and 300 mg three times daily on day 3; the dose is then titrated as needed for pain relief to the range of 1800 to 3600 mg/day in three divided doses. For the extended-release formulation of gabapentin, one regimen begins with 300 mg on day 1, 600 mg on day 2, 900 mg once daily on days 3 to 6, 1200 mg once daily on days 7 to 10, 1500 mg once daily on days 11 to 14, and 1800 mg once daily on day 15 and thereafter. Adjustment for renal impairment is required for both immediate and extended release, and use of extended release is not recommended in patients with severe renal impairment.

 

Pregabalin — Pregabalin is a structural analog of gamma-aminobutyric acid (GABA) and is similar to gabapentin. Based on placebo-controlled trials and absent direct comparisons with gabapentin, it is also a reasonable first-line choice for postherpetic neuralgia.

 

The recommended starting dose for pregabalin(immediate release) is 150 mg, divided into two or three doses daily, and increased to a total daily dose of 300 mg based upon tolerability and effect. Further titration (to 600 mg daily) after two to four weeks may be considered in patients who do not experience sufficient relief of pain, provided they are able to tolerate pregabalin. An extended-release preparation is also available for once-daily dosing. Adjustment for renal impairment is required for both immediate and extended release, and use of extended release is not recommended in patients with severe renal impairment. Common side effects are dizziness, somnolence, dry mouth, peripheral edema, and weight gain. When stopping the drug it should be tapered over a week, as withdrawal symptoms may occur.

 

REF. UpToDate 2019.11.23