From the Guidelines
Alternatives to Gabapentin for pain management include duloxetine, pregabalin, tricyclic antidepressants (TCAs), and topical capsaicin.
Alternatives to Gabapentin
- Duloxetine: a serotonin-norepinephrine reuptake inhibitor (SNRI) with moderate-quality evidence for its effectiveness in reducing pain in diabetic neuropathy 1.
- Pregabalin: an anticonvulsant with high-quality evidence for its effectiveness in treating neuropathic pain, including diabetic neuropathy and postherpetic neuralgia 1.
- Tricyclic antidepressants (TCAs): such as amitriptyline and nortriptyline, with low NNTs (3.6 and 3.1, respectively) for at least moderate pain relief in neuropathic pain 1.
- Topical capsaicin: a topical treatment with high-quality evidence for its effectiveness in treating pain in diabetic neuropathy, particularly in patients with contraindications to oral pharmacotherapy or who prefer topical treatments 1.
Other Options
- Sodium channel blockers: such as lamotrigine, lacosamide, oxcarbazepine, and valproic acid, with medium-quality evidence for their effectiveness in treating pain in diabetic neuropathy 1.
- Tapentadol and Tramadol: centrally acting opioid analgesics with some evidence for their effectiveness in treating neuropathic pain, but with a risk of addiction and should be avoided for chronic neuropathic pain management 1.
From the FDA Drug Label
Clinical Studies 14. 1 Postherpetic Neuralgia Gabapentin was evaluated for the management of postherpetic neuralgia (PHN) in two randomized, double-blind, placebo-controlled, multicenter studies. The FDA drug label does not answer the question.
From the Research
Alternatives to Gabapentin for Pain Management
- Pregabalin is a potential alternative to gabapentin for pain management, as it is a GABA analogue closely related to gabapentin 2.
- Pregabalin has been approved for use in treating refractory partial epilepsy and neuropathic pain, and has been shown to be effective in reducing pain scores in patients with diabetes or post-herpetic neuralgia 2.
- Tricyclic antidepressants, such as amitriptyline, are also used to treat neuropathic pain and may be considered as an alternative to gabapentin 2, 3.
- Other antiepileptic drugs, such as carbamazepine, may also be used to treat neuropathic pain, although the evidence for their effectiveness is limited 3, 4.
Comparison of Gabapentin and Pregabalin
- A retrospective cohort study found that there was no significant difference in pain reduction between gabapentin and pregabalin, but that pregabalin may have better tolerability and a lower pill burden 5.
- Another study found that gabapentin and pregabalin had similar efficacy in treating neuropathic pain, but that pregabalin may have a more favorable adverse effect profile 2.