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Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial
C P Watson1, L Vernich, M Chipman
1Etobicoke General Hospital, Canada.
Neurology
|October 22, 1998
Summary
Nortriptyline (NT) and amitriptyline (AT) offer similar pain relief for postherpetic neuralgia (PHN). NT showed fewer side effects, suggesting a direct analgesic effect independent of antidepressant properties.
Area of Science:
- Neurology
- Pharmacology
- Pain Management
Background:
- Amitriptyline (AT) is a common treatment for postherpetic neuralgia (PHN).
- Nortriptyline (NT), a metabolite of AT, was investigated for potentially greater efficacy.
Purpose of the Study:
- To compare the effectiveness and side effect profiles of AT and NT in PHN patients.
- To determine if NT's analgesic action in PHN is independent of antidepressant effects.
Main Methods:
- A randomized, double-blind, crossover trial involving 33 PHN patients.
- Assessment of pain relief, mood, disability, and patient satisfaction using visual analog scales.
Main Results:
- 67.7% of patients (21/31) reported good pain relief with AT or NT.
- No significant differences were observed in pain relief, mood, or disability between the two drugs.
- Intolerable side effects were more frequent with AT; NT demonstrated a comparable analgesic effect with fewer adverse events.
Conclusions:
- Nortriptyline (NT) provides a scientific basis for analgesic action in PHN, separate from antidepressant effects.
- Both AT and NT demonstrate similar analgesic efficacy for most individuals with PHN.
- NT is associated with fewer side effects compared to AT.