I posted 3 rants on Neurontin in May and July – The whistle blower and Warner-Lambert, The Neurontin story, and More on Neurontin. These rants received many comments from angry users (who blame many side effects on these drugs.
One of my guiding principles is to carefully look at the data rather than anecdotes. Thus, this article caught my eye – Gabapentin Safe, Effective for Chronic Daily Headache. CDH patients challenge the best physicians. You know something is wrong, but you do not know what, nor how to help. You would like to avoid chronic narcotics, but does anything else help?
The primary efficacy measure, percentage of headache-free days per treatment period, was 9.1% less with gabapentin treatment than with placebo (P = .0005). Gabapentin was also superior to placebo in headache-free days per month (P = .0005), severity (P = .05), Visual Analogue Scale score (P = .0006), nausea (P = .03), photophobia/sonophobia (P = .04), disability affecting normal activities (P = .02), attacks requiring bed rest (P = .001); and quality of life related to bodily function (P = .01), health/vitality (P = .0001), social function (P = .006), and health transition (P = .0002).
“Consequent to these benefits there was a reduction in analgesic usage,” the authors write. “Whereas gabapentin appeared to have a greater efficacy in those with lower prerandomization headache frequency, the benefit was seen across the frequency spectrum including those with headaches occurring every day.”
Parke Davis supported this study.
In an accompanying commentary, Stephen D. Silberstein, MD, FACP, notes that patients with CDH are difficult to treat. He identifies study limitations including lack of defined criteria for CDH subtypes and failure to account for analgesic use. “Although their results were significant, they were modest and may not be clinically important,” he writes. “Future CDH studies require subset analysis and control for acute medication overuse.”
So do these results make trying this high dose of gabapentin worthwhile? I guess I will consider offering the option (with a full disclosure of known side effects) and let the patient decide. These results do not appear outstanding and as the editorialist points out, they are modest. But sometimes modest is all we can hope for.
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