Antiepileptics for Post-Herpetic Neuralgia in the Elderly: Current and Future Prospects
- 304 Downloads
Post-herpetic neuralgia is a painful condition and its prevalence increases with age. It is a burden for older patients and the association of age-related pharmacokinetic and pharmacodynamic changes, high co-morbidity and polypharmacy leads to the risk of adverse drug reactions and interactions. This type of neuropathic pain is particularly difficult to treat and guidelines recommend the use of gabapentinoids and some antidepressants, the utility of which may be hampered by adverse effects such as sedation, dizziness and impaired age-related renal function. Re-formulations of antiepileptics (anticonvulsants) are being developed and/or marketed and suggest interesting innovative profiles with improved bioavailability, low drug–drug interactions and better tolerability that need to be confirmed in future studies. However, there are no new antiepileptics being developed for post-herpetic neuralgia, and prospective studies specifically focused on the older population are still missing, while this age group is particularly at risk of developing shingles and chronic neuropathic pain with a deleterious impact on quality of life.
KeywordsNeuropathic Pain Gabapentin Pregabalin Duloxetine American Geriatrics Society
No conflict of interest to declare.
No source of funding to declare.
- 35.Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009;(3):CD007076.Google Scholar
- 39.Gordi T, Hou E, Kasichayanula S, Berner B. Pharmacokinetics of gabapentin after a single day and at steady state following the administration of gastric-retentive- extended-release and immediate-release tablets: a randomized, open-label, multiple-dose, three-way crossover, exploratory study in healthy subjects. Clin Ther. 2008;30(5):909–16.PubMedCrossRefGoogle Scholar
- 42.Cundy KC, Branch R, Chernov-Rogan T, et al. XP13512 [(±)-1-([(alpha-isobutanoyloxyethoxy)carbonyl] aminomethyl)-1-cyclohexane acetic acid], a novel gabapentin prodrug: I. Design, synthesis, enzymatic conversion to gabapentin, and transport by intestinal solute transporters. J Pharmacol Exp Ther. 2004;311(1):315–23.PubMedCrossRefGoogle Scholar
- 48.Pfizer report. Pfizer reports top-line results of a phase 3 study evaluating pregabalin controlled-release formulation as adjunctive treatment in adult patients with partial onset seizures. http://www.dailyfinance.com/2012/11/16/pfizer-reports-top-line-results-of-a-phase-3-study/. Accessed 31 July 2014.
- 49.Chew M, Plotka A, Alvey C, Pitman V, Alebic-Kolbah T, Scavone J, et al. Effect of food and dose on pregabalin controlled release pharmacokinetics in healthy volunteers [abstract]. J Pain. 2013;14(4 Suppl):S66.Google Scholar
- 50.Pfizer. Safety and efficacy study of once daily controlled release pregabalin in the treatment of patients with postherpetic neuralgia (ClinicalTrials.gov identifier NCT01270828). US National Institutes of Health, ClinicalTrials.gov. http://clinicaltrials.gov/ct2/show/NCT01270828?term=NCT01270828&rank=1. Accessed 31 July 2014.
- 51.Falcão A, Fuseau E, Nunes T, Almeida L, Soares-da-Silva P. Pharmacokinetics, drug interactions and exposure-response relationship of eslicarbazepine acetate in adult patients with partial-onset seizures: population pharmacokinetic and pharmacokinetic/pharmacodynamic analyses. CNS Drugs. 2012;26(1):79–91.PubMedCrossRefGoogle Scholar
- 54.Bial-Portela & Cª, S.A. Efficacy and safety of eslicarbazepine acetate as therapy for patients with post-herpetic neuralgia (ClinicalTrials.gov identifier NCT00981227). US National Institutes of Health, ClinicalTrials.gov, 2014. http://www.clinicaltrials.gov/ct2/show/results/NCT00981227?term=NCT00981227&rank=1. Accessed 9 Jul 2014.
- 55.Bial-Portela & Cª, S.A. Eslicarbazepine acetate as therapy in post-herpetic neuralgia (ClinicalTrials.gov identifier NCT01124097). US National Institutes of Health, ClinicalTrials.gov, 2014. https://clinicaltrials.gov/ct2/show/NCT01124097?term=NCT01124097&rank=1. Accessed 17 Jul 2014.
- 56.Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C, Ali H, Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;63(6):959–65.PubMedCrossRefGoogle Scholar
- 57.Wiffen PJ, Derry S, Moore RA, McQuay HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev. 2011;(1):CD005451.Google Scholar
- 59.Gilron I, Dickenson AH. Emerging drugs for neuropathic pain. Expert Opin Emerg Drugs. Epub 2014 May 3.Google Scholar
- 60.Valeant Pharmaceuticals International, Inc. Safety/efficacy study of retigabine vs. placebo in post-herpetic neuralgia (PHN) (ClinicalTrials.gov identifier NCT00612105). US National Institutes of Health, ClinicalTrials.gov. http://clinicaltrials.gov/ct2/show/NCT00612105?term=NCT00612105&rank=1. Accessed 31 July 2014.
- 61.Valeant Pharmaceuticals International Inc. Valeant Pharmaceuticals announces preliminary results from its phase IIa retigabine study for the treatment of postherpetic neuralgia (PHN). 2009. http://ir.valeant.com/investor-relations/news-releases/news-release-details/2009/Valeant-Pharmaceuticals-Announces-Preliminary-Results-From-Its-Phase-IIa-Retigabine-Study-for-the-Treatment-of-Postherpetic-N/default.aspx. Accessed 9 Jul 2014.