Korean J Pain.  2017 Jul;30(3):183-191. 10.3344/kjp.2017.30.3.183.

Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations?

• Kamble SV
• Motlekar S
• D'souza LL
• Kudrigikar VN
• Rao SE

• KMID: 2385350
• DOI: http://doi.org/10.3344/kjp.2017.30.3.183

Abstract

BACKGROUND
Current therapy for the treatment of neuropathic pain is often unsatisfactory. Considerable variation in treatment pattern still exists in spite of availability of sufficient literature from various guidelines. Recent Indian market data suggested that the utilization (sale) of drugs such as amitriptyline, pregabalin, and gabapentin was more for low-dose unit packs than that of the high-dose unit packs, raising the belief that these drugs are prescribed at a lower dose than is actually recommended in the guidelines. To test this hypothesis, a survey was conducted across speciality throughout the country to observe the prescription pattern of these drugs amongst the health care providers in India.
METHODS
Three hundred fifty survey forms were distributed of which 281 forms were included for analysis.
RESULTS
It was observed that the commonly used initiation and maintenance dose for amitriptyline, pregabalin, and gabapentin was 5-10 mg/day, 50-75 mg/day, and 100-300 mg/day, respectively. The reason to select the lower dosages was to have a balancing effect to achieve good efficacy with minimum side effects. Care-givers reported no side effects/not many side effects as a reason in 22.2%, 16.88%, and 23.86% patients with amitriptyline, pregabalin, and gabapentin, respectively. Sedation and giddiness were commonly reported with all three drugs.
CONCLUSIONS
Commonly prescribed drugs for management of neuropathic pain, such as amitriptyline, pregabalin, and gabapentin are preferred at lower doses in Indian clinical settings. Acceptable efficacy and low tolerance to the standard dosage is believed to be the reason behind the prescribed dose.

Keyword

Administration and dosage; Amitriptyline; Analysis; Gabapentin; Neuropathic pain; Pregabalin; Prescriptions; Surveys and questionnaires

MeSH Terms

Amitriptyline*
Health Personnel
Humans
India*
Neuralgia*
Pregabalin*
Prescriptions
Surveys and Questionnaires
Amitriptyline
Pregabalin

Figure

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  Fig. 1 Dose of amitriptyline used for initiation and maintenance therapy for management of neuropathic pain.

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  Fig. 2 Dose of pregabalin used for initiation and maintenance therapy for management of neuropathic pain.

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  Fig. 3 Dose of gabapentin used for initiation and maintenance therapy for management of neuropathic pain.

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