Nortriptyline versus amitriptyline in postherpetic neuralgia

Watson, C. Peter N.; Vernich, L.; Chipman, Mary L.; Reed, Kenneth L.

doi:10.1212/wnl.51.4.1166

Cited by 297 publications

(143 citation statements)

References 4 publications

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“…Nos idosos, é preferível utilizar a nortriptilina em uma dose inicial de 25mg administrada a cada 8 horas, que poderá ser aumentada até um máximo de 150mg/dia. 17 Os efeitos secundários, nomeadamente o efeito sedativo, são menos marcados do que os observados com a amitriptilina. O tratamento deve ser mantido durante um mínimo de 6 a 8 semanas, uma vez que os efeitos benéficos são ocasionalmente tardios.…”

Section: Discussionunclassified

Neuralgia pós-herpética: dois casos clínicos

Serrano

Valente

2014

Rev Bras Med Fam Comunidade

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ResumoA neuralgia pós-herpética (NPH) é a complicação mais frequente do herpes-zóster, caracterizando-se pela presença de dor tipo neuropática de distribuição dermatômica, após manifestação prévia de um quadro agudo de herpes-zóster, geralmente um mês depois do surgimento das vesículas. O objetivo do presente relato é apresentar dois casos clínicos de NPH e suas respostas a diferentes tratamentos. O primeiro caso apresentou intolerância à amitriptilina e uma boa resposta clínica à gabapentina na dosagem de 900 mg/dia. O segundo caso apresentou intolerância à capsaicina, mas apresentou boa resposta à combinação da pregabalina com lidocaína tópica. A gabapentina, a pregabalina e a lidocaína tópica são tratamentos eficazes para o tratamento da neuralgia pós-herpética. Todas essas recomendações vão ao encontro dos tratamentos utilizados pelos médicos de família nos dois casos apresentados neste estudo. AbstractPostherpetic neuralgia (PHN) is the most common complication of Herpes Zoster, characterized by the presence of neuropathic-type pain limited to a dermatomic area after outbreak of Herpes Zoster (commonly known as shingles), usually a month after the appearance of vesicles on the skin . The aim of this report is to present two cases of PHN and their responses to different treatments. The first case presented intolerance to amitriptyline and a good clinical response to gabapentin at a dose of 900 mg/day. The second case showed intolerance to capsaicin but responded well to the combination of pregabalin and topical lidocaine. Gabapentin, pregabalin and lidocaine are effective for the treatment of postherpetic neuralgia. All these recommendations are consistent with those treatments used by the family physicians in the two case studies presented. ResumenLa neuralgia postherpética (NPH) es la complicación más común de herpes zoster, que se caracteriza por la presencia de dolor tipo neuropático de distribución dermatómica después de una manifestación previa de cuadro agudo de herpes zoster, generalmente un mes después de la aparición de las vesículas en la piel. El objetivo de este relato es presentar dos casos de NPH y sus respuestas a diferentes tratamientos. El primer caso presento intolerancia a la amitriptilina y una buena respuesta clínica a la gabapentina en la dosis de 900 mg/día. El segundo caso mostró intolerancia a la capsaicina, pero mostró una buena respuesta a la combinación de pregabalina associado con lidocaína tópica. La gabapentina, pregabalina y la lidocaína son eficaces para el tratamiento de la neuralgia postherpética. Todas estas recomendaciones son coherentes con los tratamientos utilizados por el médico de familia en dos casos presentados en este estudio.

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Section: Discussionunclassified

Neuralgia pós-herpética: dois casos clínicos

Serrano

Valente

2014

Rev Bras Med Fam Comunidade

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“…Although amitriptyline was tested in many PHN trials it is often poorly tolerated in older adults because of its much higher anticholinergic activity. Nortriptyline has equivalent efficacy compared to amitriptyline in PHN but is better tolerated (28). Desipramine is a reasonable alternative to nortriptyline.…”

Section: Postherpetic Neuralgiamentioning

confidence: 98%

Herpes Zoster and Postherpetic Neuralgia in Older Adults

Schmader

2007

Clinics in Geriatric Medicine

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SynopsisHerpes zoster afflicts millions of older adults annually worldwide and causes significant suffering due to acute and chronic pain, or postherpetic neuralgia (PHN). Herpes zoster is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living and reduced quality of life in older adults. To address these problems, the optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who develop PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, and/or opiates can reduce pain burden. The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults. KeywordsHerpes zoster; varicella-zoster virus; postherpetic neuralgia; elderly; aged IntroductionHerpes zoster is a neurocutaneous disease that is caused by the reactivation of varicellazoster virus (VZV) from a latent infection of dorsal sensory or cranial nerve ganglia following primary infection with VZV earlier in life. VZV is a double-stranded DNA herpesvirus with a genome that contains at least 70 gene products (1). VZV expresses gene products and attempts replication throughout life but cellular immunity is critical to containing VZV. With aging-related decline in cellular immunity to VZV, the virus may escape cell-mediated immune containment and spread in the affected ganglia and sensory nerves to the skin.Address correspondence to Dr. Schmader at 182 GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA, telephone: 919-286-6932, fax: 919-286-6823, kenneth.schmader@duke.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript EpidemiologyThe estimated incidence of herpes zoster in persons older than 65 years old varies from approximately 10 to 14 cases per 1000 per year (2-4). The lifetime incidence of herpes zoster is estimated to be about 20-30% in the general population and maybe as high as 50% among those surviving to 85 years or higher (5). Current population figures and herpes zoster incidence data yield estimates of about 1 million new cases of herpes zoster each year in the United States (6). The incidence of recurrent herpes zoster is not as well established but the frequency of recurrent events is hig...

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“…Among this class, the most commonly used compounds are amitriptyline, nortriptyline and desipramine. Amitriptyline led to a reduction in pain in 47-66% of patients, desipramine and nortriptyline in 55% to 63% (Schamder, 2001;Watson et al, 1998). Nortriptyline and desipramine are generally preferred to amitriptyline because of lower incidence of anticholinergic side effects such as sedation, orthostatic hypotension, cognitive decline, and constipation (Watson et al, 1998).…”

Section: Antidepressantsmentioning

confidence: 99%

“…Amitriptyline led to a reduction in pain in 47-66% of patients, desipramine and nortriptyline in 55% to 63% (Schamder, 2001;Watson et al, 1998). Nortriptyline and desipramine are generally preferred to amitriptyline because of lower incidence of anticholinergic side effects such as sedation, orthostatic hypotension, cognitive decline, and constipation (Watson et al, 1998). Furthermore, despite amitriptyline is probably the most widely studied TCA for the treatment of PHN, nortriptyline and desipramine have recently been shown to be equally effective (Watson & Oaklander, 2002;Hempenstall et al, 2005;Rowbotham et al, 2005).…”

Section: Antidepressantsmentioning

confidence: 99%