Gabapentin: new indication. In postherpetic neuralgia when amitriptyline fails

(1) Postherpetic pain is infrequent, but the incidence increases with age. (2) The reference treatment for postherpetic pain is oral amitriptyline or desipramine. (3) Gabapentin, an antiepileptic agent, is the first drug to be granted specific approval in France for the treatment of postherpetic pain. (4) In two placebo-controlled trials, gabapentin at a dose of between 1 800 and 3 600 mg/day halved the intensity of pain in about one in three patients. In comparison, pain improved in about 50% of patients taking amitriptyline in clinical trials. (5) Both gabapentin and amitriptyline provoke sedation, but dizziness and peripheral oedema are more frequent on gabapentin, while atropinic effects predominate with amitriptyline. (6) Daily treatment is 10 times more costly in France. (7) In practice, the standard treatment of postherpetic pain remains oral amitriptyline or desipramine. Gabapentin is an alternative, given its different safety profile.