Long-term treatment of trigeminal neuralgia with carbamazepine

Abstract

SummaryThe results of treating 143 patients with trigeminal neuralgia with carbamazepine (CBZ) over a 16-year period have been reviewed. The drug was effective initially with few mild side effects in 99 patients (69 %). Of these, 19 developed resistance later, i.e. between 2 months and 10 years after commencing treatment, and required alternative measures. Of the remaining 80 (56 %), the drug was effective in 49 for 1-4 years and in 31 for 5-16 years. Thirty-six patients (25%) failed to respond to CBZ initially and required alternative measures, as did 8 (6 %) who were intolerant of the drug. One patient developed CBZ-induced water intoxication with hyponatraemia. Subsequently hyponatraemia was excluded in 17 patients who had been taking CBZ for between 4 months and 7 years. This study has thus confirmed the efficacy of CBZ in the treatment of trigeminal neuralgia and shown that it may continue to be effective for many years.

Treatment options in trigeminal neuralgia

“…As the incidence of TN increases with age [Khan, 1998], age-related physiologic changes that alter pharmacokinetics, such as reduced hepatic and renal function, blood flow decline, less predictable drug protein binding and interactions with multiple other medications required due to concomitant illness, will come increasingly into focus. Approximately 610% of patients cannot tolerate CBZ [Taylor et al 1981]. Multiple pharmacologic interactions and a narrow therapeutic window of tolerability further limit the use of CBZ.…”

Gabapentin Supplemented With Ropivacain Block of Trigger Points Improves Pain Control and Quality of Life in Trigeminal Neuralgia Patients When Compared With Gabapentin Alone

“…1,5 However, the main problem concerning the use of ACs is the tolerance to the drug doses controlling pain, owing to side effects (dizziness, somnolence, and ataxias). 4,6 The absence of CBZ efficacy in some patients, cases of intolerance, 7 hypersensitivity, fluid retention, 8 drug interactions, a narrower therapeutic index and a higher degree of adverse side effects than recent drugs like gabapentin (GBP) has led to a progressively increased use of the latter drug in several neuropathic pain syndromes. [9][10][11][12] GBP has been used alone 13 or in association with CBZ or iamotrigine 14 and results in pain reduction in at least 47% of TN patients.…”

Evidence-based pharmacological management of chronic neuropathic pain

“…The NNT for gabapentin/pregabalin was 4.7 (4.0 -5.6); for opioid, 2.5 (2.0-3.2) and for tramadol, 3.9 (2.7-6.7). The NNH for TCAs was 14.7 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), for gabapentin/pregabalin, 17.8 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), for opioid, 17.1 (10-66) and for tramadol, 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). If analgesia is the only criterion for selection, then the chronology of preference would probably be TCAs> opioids ≥ tramadol ≥ gabapentin/pregabalin.…”

“…A study of 143 patients with trigeminal neuralgia treated with carbamazepine over a 16-year period, confirmed a sustained analgesia in patients who responded to carbamazepine and suggested that it may continue to be effective for many years. 30 Oxcarbazepine is chemical structure similar to carbamazepine, but with different metabolism. Studies have confirmed that oxcarbazepine has potent antineuralgic properties in the absence of significant side effects, and, can be offered as an agent of first-choice or in those who have not responded to carbamazepine.…”