From the Guidelines
Gabapentin is a highly effective treatment for pain associated with shingles, particularly postherpetic neuralgia, with a recommended starting dose of 100-300 mg at bedtime or 100-300 mg three times daily, gradually increasing as tolerated to a maximum dose of 3600 mg daily in three divided doses 1.
Key Considerations
- The dosage of gabapentin should be adjusted based on pain control and side effects, with treatment typically continuing for several months 1.
- Gabapentin works by binding to calcium channels in the nervous system, reducing abnormal electrical activity and neurotransmitter release that causes neuropathic pain.
- Common side effects of gabapentin include dizziness, drowsiness, and peripheral edema, which can be minimized by starting with a low dose and gradually increasing 1.
- Patients should take gabapentin with food to reduce stomach upset, avoid abrupt discontinuation which can cause withdrawal symptoms, and be aware that the medication may cause drowsiness affecting driving or operating machinery.
Special Populations
- Elderly patients and those with kidney impairment typically require lower doses of gabapentin, with careful monitoring of side effects and dosage adjustments as needed 1.
- Gabapentin can be used in combination with other medications, such as opioids, antidepressants, and topical agents, to enhance analgesia and reduce systemic opioid requirements 1.
Alternative Options
- Pregabalin is an alternative anticonvulsant medication that can be used to treat neuropathic pain, with a similar efficacy and tolerability profile to gabapentin 1.
- Topical lidocaine patches can also be used to relieve neuropathic pain, particularly in patients with postherpetic neuralgia or allodynia 1.
From the FDA Drug Label
Gabapentin tablets are a prescription medicine used to treat: Pain from damaged nerves (postherpetic pain) that follows healing of shingles (a painful rash that comes after a herpes zoster infection) in adults
Gabapentin was evaluated for the management of postherpetic neuralgia (PHN) in two randomized, double-blind, placebo-controlled, multicenter studies.
The role of gabapentin in treating pain associated with shingles is to manage postherpetic neuralgia (PHN), which is pain from damaged nerves that follows healing of shingles. Gabapentin has been shown to be effective in reducing pain scores in patients with PHN, with the reduction in weekly mean pain scores seen by Week 1 and maintained to the end of treatment 2 2.
- Key points:
- Gabapentin is used to treat pain from damaged nerves (postherpetic pain) that follows healing of shingles in adults.
- Gabapentin has been evaluated in two randomized, double-blind, placebo-controlled, multicenter studies for the management of postherpetic neuralgia (PHN).
- The studies demonstrated efficacy of gabapentin compared to placebo at all doses tested.
From the Research
Role of Gabapentin in Treating Pain Associated with Shingles
- Gabapentin is effective in the treatment of pain and sleep interference associated with postherpetic neuralgia (PHN), a common complication of shingles 3.
- The efficacy of gabapentin in reducing PHN pain has been demonstrated in a randomized controlled trial, where subjects receiving gabapentin had a statistically significant reduction in average daily pain score compared to those receiving placebo 3.
- Gabapentin has also been shown to improve mood and quality of life in patients with PHN 3.
Use of Gabapentin in Acute Herpes Zoster
- The use of low-dose gabapentin in acute herpes zoster may not be effective in preventing PHN, as suggested by a prospective randomized controlled study 4.
- A double-blind, randomized controlled trial found that a 5-week course of gabapentin did not provide significant relief from acute herpetic pain or prevention of PHN 5.
Comparison with Other Treatments
- A comparative study found that pregabalin was more effective than amitriptyline in treating postherpetic neuralgia, with satisfactory improvements in pain perception noticed in the pregabalin group 6.
- Gabapentin has been used in combination with other treatments, such as vitamin C and physical therapy, to treat complex regional pain syndrome following an episode of herpes zoster, but its effectiveness in this context is unclear 7.