Skip to main content
SpringerLink
Log in

Antiepileptics for Post-Herpetic Neuralgia in the Elderly: Current and Future Prospects

  • Leading Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brisson M, Edmunds WJ, Law B, Gay NJ, Walld R, Brownell M, et al. Epidemiology of varicella zoster virus infection in Canada and the United Kingdom. Epidemiol Infect. 2001;127:305–14.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Soc Med. 1965;58:9–20.

    PubMed  CAS  PubMed Central  Google Scholar 

  3. Yawn BP, Saddier P, Wollan PC, St. Sauver JL, Kurland MJ, Sy LS. A population based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82:1341–9.

    Article  PubMed  Google Scholar 

  4. Bouhassira D, Chassany O, Gaillat J, Hanslik T, Launay O, Mann C, et al. Patient perspective on herpes zoster and its complications: an observational prospective study in patients aged over 50 years in general practice. Pain. 2012;153:342–9.

    Article  PubMed  Google Scholar 

  5. Lee VK, Simpkins L. Herpes zoster and postherpetic neuralgia in the elderly. Geriatr Nurs. 2000;21(3):132–5.

    Article  PubMed  CAS  Google Scholar 

  6. Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice AS, et al. A new definition of neuropathic pain. Pain. 2011;152(10):2204–5.

    Article  PubMed  Google Scholar 

  7. Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008;9(1 Suppl 1):S37–44.

    Article  PubMed  Google Scholar 

  8. Johnson RW. Zoster-associated pain: what is known, who is at risk and how can it be managed? Herpes. 2007;14(Suppl 2):30–4.

    PubMed  Google Scholar 

  9. Pickering G, Leplege A. Herpes zoster pain, post-herpetic neuralgia and quality of life in the elderly. Pain Pract. 2011;11:397–402.

    Article  PubMed  Google Scholar 

  10. Apkarian AV, Hashmi JA, Baliki MN. Pain and the brain: specificity and plasticity of the brain in clinical chronic pain. Pain. 2011;152(3 Suppl):S49–64.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Pickering G, Pereira B, Clère F, Sorel M, de Montgazon G, Navez M, et al. Cognitive function in older patients with postherpetic neuralgia. Pain Pract. 2013;14(1):E1–7.

    Article  PubMed  Google Scholar 

  12. Dworkin RH, O’Connor AB, Audette J, Baron R, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3–14.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  13. Dworkin RH, Panarites CJ, Armstrong EP, Malone DC, Pham SV. Is treatment of postherpetic neuralgia in the community consistent with evidence-based recommendations? Pain. 2012;153(4):869–75.

    Article  PubMed  Google Scholar 

  14. Britt HC, Harrison CM, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189:72–7.

    PubMed  Google Scholar 

  15. Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867–78.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  16. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002;287:337–44.

    Article  PubMed  Google Scholar 

  17. Lally F, Crome P. Understanding frailty. Postgrad Med J. 2007;83(975):16–20.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146.

    Article  PubMed  CAS  Google Scholar 

  19. Pickering G. Analgesic use in the older person. Curr Opin Support Palliat Care. 2012;6(2):207–12.

    Article  PubMed  Google Scholar 

  20. Schmader KE, Baron R, Haanpaa ML, Mayer J, O’Connor AB, Rice ASC, et al. Treatment considerations for elderly and frail patients with neuropathic pain. Mayo Clin Proc. 2010;85(3 suppl):S26–32.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Szczerbinska K, Topor-Madry R. Association between central nervous system drugs and recurrent falling based on prospective falls registration in nursing homes. Eur Geriatr Med. 2013;3:82–6.

    Article  Google Scholar 

  22. Gloth FM. Pharmacological management of persistent pain in older persons: focus on opioids and nonopioids. J Pain. 2011;12(3 Suppl 1):S14–20.

    Article  PubMed  CAS  Google Scholar 

  23. AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50:S205–24.

    Article  Google Scholar 

  24. O’Connor KM, Paauw DS. Herpes zoster. Med Clin North Am. 2013;97:503–22.

    Article  PubMed  Google Scholar 

  25. Freynhagen R, Strojek K, Griesing T, Whalen E, Balkenohl M. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain. 2005;115(3):254–63.

    Article  PubMed  CAS  Google Scholar 

  26. Field TS, Gurwitz JH, Avorn J, McCormick D, Jain S, Eckler M, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161(13):1629–34.

    Article  PubMed  CAS  Google Scholar 

  27. Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30–9.

    PubMed  CAS  Google Scholar 

  28. Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007;62(10):1172–81.

    Article  PubMed  Google Scholar 

  29. Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001;54(8):837–44.

    Article  PubMed  CAS  Google Scholar 

  30. Ensrud KE, Blackwell TL, Mangione CM, Bowman PJ, Whooley MA, Bauer DC, et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc. 2002;50(10):1629–37.

    Article  PubMed  Google Scholar 

  31. Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007;57:S136–42.

    Article  PubMed  Google Scholar 

  32. Rice AS, Maton S, Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomized, double blind, placebo controlled study. Pain. 2001;94:215–24.

    Article  PubMed  CAS  Google Scholar 

  33. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA. 1998;280:1837–42.

    Article  PubMed  CAS  Google Scholar 

  34. Dworkin RH, Corbin AE, Young JP Jr, Sharma U, LaMareaux L, Bockbrader H, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2003;60:1274–83.

    Article  PubMed  CAS  Google Scholar 

  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.

  36. Semel D, Murphy TK, Zlateva G, Cheung R, Emir B. Evaluation of the safety and efficacy of pregabalin in older patients with neuropathic pain: results from a pooled analysis of 11 clinical studies. BMC Fam Pract. 2010;5(11):85.

    Article  Google Scholar 

  37. Beal B, Moeller-Bertram T, Schilling JM, Wallace MS. Gabapentin for once-daily treatment of post-herpetic neuralgia: a review. Clin Interv Aging. 2012;7:249–55.

    PubMed  CAS  PubMed Central  Google Scholar 

  38. Gupta A, Li S. Safety and efficacy of once-daily gastroretentive gabapentin in patients with postherpetic neuralgia aged 75 years and over. Drugs Aging. 2013;30(12):999–1008.

    Article  PubMed  CAS  PubMed Central  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.

    Article  PubMed  CAS  Google Scholar 

  40. Wallace MS, Irving G, Cowles VE. Gabapentin extended-release tablets for the treatment of patients with postherpetic neuralgia: a randomized, double-blind, placebo-controlled, multicentre study. Clin Drug Investig. 2010;30(11):765–76.

    Article  PubMed  CAS  Google Scholar 

  41. Sang CN, Sathyanarayana R, Sweeney M, et al. Gastroretentive gabapentin (G-GR) formulation reduces intensity of pain associated with postherpetic neuralgia (PHN). Clin J Pain. 2013;29(4):281–8.

    Article  PubMed  Google 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.

    Article  PubMed  CAS  Google Scholar 

  43. Thomas B, Farquhar-Smith P. Extended-release gabapentin in post-herpetic neuralgia. Expert Opin Pharmacother. 2011;12(16):2565–71.

    Article  PubMed  CAS  Google Scholar 

  44. Lal R, Sukbuntherng J, Luo W, Tovera J, Lassauzet ML, Cundy KC. Population pharmacokinetics and pharmacodynamics of gabapentin after administration of gabapentin enacarbil. J Clin Pharmacol. 2013;53(1):29–40.

    Article  PubMed  Google Scholar 

  45. Backonja MM, Canafax DM, Cundy KC. Efficacy of gabapentin enacarbil vs placebo in patients with postherpetic neuralgia and a phar-macokinetic comparison with oral gabapentin. Pain Med. 2011;12(7):1098–108.

    Article  PubMed  Google Scholar 

  46. Thomas BM, Farquhar-Smith P. Gabapentin enacarbil extended release for the treatment of postherpetic neuralgia in adults. Ther Clin Risk Manag. 2013;9:469–75.

    PubMed  PubMed Central  Google Scholar 

  47. Zhang L, Rainka M, Freeman R, et al. A randomized, double-blind, placebo controlled trial to assess the efficacy and safety of gabapentin enacarbil in subjects with neuropathic pain associated with postherpetic neuralgia (PXN110748). J Pain. 2013;14(6):590–603.

    Article  PubMed  CAS  Google 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.

  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.

    Article  PubMed  Google Scholar 

  52. Bialer M, Soares-da-Silva P. Pharmacokinetics and drug interactions of eslicarbazepine acetate. Epilepsia. 2012;53(6):935–46.

    Article  PubMed  CAS  Google Scholar 

  53. Verrotti A, Loiacono G, Rossi A, Zaccara G. Eslicarbazepine acetate: an update on efficacy and safety in epilepsy. Epilepsy Res. 2014;108(1):1–10.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  CAS  Google 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.

  58. Kim JY, Lee J, Ko YJ, Shin JY, Jung SY, Choi NK, et al. Multi-indication carbamazepine and the risk of severe cutaneous adverse drug reactions in Korean elderly patients: a Korean health insurance data-based study. PLoS One. 2013;8(12):e83849.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Gilron I, Dickenson AH. Emerging drugs for neuropathic pain. Expert Opin Emerg Drugs. Epub 2014 May 3.

  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.

  62. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005;118:289–305.

    Article  PubMed  CAS  Google Scholar 

  63. Johnson P, Becker L, Halpern R, Sweeney M. Real-world treatment of post-herpetic neuralgia with gabapentin or pregabalin. Clin Drug Investig. 2013;33:35–44.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Gore M, Sadosky A, Tai KS, Stacey B. A retrospective evaluation of the use of gabapentin and pregabalin in patients with postherpetic neuralgia in usual-care settings. Clin Ther. 2007;29(8):1655–70.

    Article  PubMed  CAS  Google Scholar 

  65. Lötsch J, Geisslinger G. Pharmacogenetics of new analgesics. Br J Pharmacol. 2011;163(447–460):447.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Law PY, Reggio PH, Loh HH. Opioid receptors: toward separation of analgesic from undesirable effects. Trends Biochem Sci. 2013;38(6):275–82.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Acknowledgments

No conflict of interest to declare.

No source of funding to declare.

Author information

Authors and Affiliations

  1. CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, 63003, Clermont-Ferrand, France

    Gisèle Pickering

  2. Inserm, CIC 1405, Neurodol-1107, 63003, Clermont-Ferrand, France

    Gisèle Pickering

  3. Laboratoire de Pharmacologie, Faculté de médecine, Clermont Université, 63001, Clermont-Ferrand, France

    Gisèle Pickering

  4. Clinical Pharmacology Centre, Bâtiment 3C, CHU, Hopital G Montpied, 63001, Clermont-Ferrand Cedex, France

    Gisèle Pickering

Authors
  1. Gisèle Pickering
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gisèle Pickering.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pickering, G. Antiepileptics for Post-Herpetic Neuralgia in the Elderly: Current and Future Prospects. Drugs Aging 31, 653–660 (2014). https://doi.org/10.1007/s40266-014-0202-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-014-0202-4

Keywords

Search

Navigation