Gabapentin (Neurontin) versus ...
Gabapentin vs. Pregabalin (Lyrica)
Difference between Gabapentin and Pregabalin chart (distinctive features are marked):
Antiepileptic, GABA analogue
|Mechanism of action
||Similar mechanism of action, but pregabalin has a stronger receptor binding affinity for the α2-δ protein subunit of voltage-gated calcium channels
||Schedule V controlled substance
Proven potential for abuse and dependence
|Common FDA approved indications
Epilepsy in adults
|Other FDA-approved indications
||Epilepsy in children age 3-12 years
Painful diabetic peripheral neuropathy,
Neuropathic pain associated with spinal cord Injury
5 to 7 hours
more prolonged duration of action
requires disproportionately larger dose increase to achieve higher plasma concentrations
more predictable dose-effect relationship
|Pain relieving potency
||pregabalin is 5 times more potent than gabapentin 11
Gabapentin and pregabalin are structurally and pharmacologically related compounds. Pregabalin is the pharmacologically active S-enantiomer of a gamma-amino acid analogue. Both anticonvulsants share many similar properties17 -- antiepileptic, analgesic, antineuropathic, and anxiolytic-like action; lack of drug interactions; minimal metabolism; renal elimination.
Pregabalin has several superior pharmacodynamic characteristics15. Pregabalin has a much higher bioavailability (90% versus 33-66%) and is rapidly absorbed (peak: 1 hour). Also, plasma concentrations increase linearly with increasing dose. Gabapentin is slowly absorbed (peak: 3 to 4 hours) and plasma concentrations have a non-linear relationship to increasing doses.
As an antiepileptic, pregabalin may be more effective than gabapentin in reducing the seizure frequency10.
In the treatment of neuropathic pain pregabalin has been shown in studies to provide equivalent efficacy to gabapentin, however, at much lower doses. The recent study of patients with neuropathic pain has shown that pregabalin can provide additional relief and improvement in quality of life in those who did not respond to gabapentin14.
Combined use of gabapentin and pregabalin
As pregabalin and gabapentin have a similar mechanism of action and properties, it makes no reason to take pregabalin concomitantly with gabapentin.
Gabapentin vs. Amitriptyline
Painful diabetic neuropathy
In the study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral
neuropathy pain, moderate or greater pain relief was experienced in
52% of patients with gabapentin and 67% of patients with amitriptyline.
Study concluded that gabapentin does not appear to offer considerable advantage over amitriptyline
and is more expensive 4.
Earlier study has shown that gabapentin produces greater improvements
than amitriptyline in pain and paresthesia associated with diabetic
Chronic pelvic pain
Gabapentin alone or in combination with amitriptyline is superior to amitriptyline alone in the treatment
of female chronic pelvic pain 3.
Peripheral neuropathic pain
In the double blind randomized trial both gabapentin and amitriptyline were effective for the management of
peripheral neuropathic pain. However, improvement in shooting pain and patient satisfaction were significantly
higher with gabapentin treatment. Also gabapentin was more effective in paroxysmal shooting pain than
in other pain qualities 6.
Safety & Side effects
Gabapentin is better tolerated than amitriptyline. Side effects occur more frequently
with amitriptyline than with gabapentin 2, 3, 6.
Gabapentin has no significant drug interactions while amitriptyline has several clinically significant drug interactions (e.g. MAOI, cisapride, thyroid agents).
Gabapentin is more costly than amitriptyline and requires frequent dosing regimen.
Gabapentin vs. Lamotrigine (Lamictal)
Unblinded randomised controlled trial has shown that lamotrigine is significantly better than gabapentin in the
treatment of partial onset seizures 1.
Gabapentin and lamotrigine are similarly effective and well tolerated in patients with newly diagnosed
epilepsy 5 and elderly patients with
|Results of randomised, double-blind study comparing gabapentin versus lamotrigine in newly diagnosed epilepsy 5
||1,200 - 3,600 mg/day for 24 weeks
||100 - 300 mg/day for 24 weeks
|Exit event, number of patients
19 of 148 patients
19 of 143 patients
|Median time to exit
|Number of patients remained seizure free during the final 12 weeks of treatment
80 of 106 patients
73 of 96 patients
|Number of patients withdrew form treatment because of drug-related adverse events
14 of 106 patients
15 of 96 patients
Controlled comparative study evaluated the efficacy of lamotrigine
and gabapentin monotherapy versus placebo in refractory bipolar
and unipolar mood disorders 12.
Response rates were the following: lamotrigine 52%; gabapentin 26%; placebo 23%.
Gabapentin vs. Carbamazepine (Tegretol)
Unblinded randomised controlled trial has shown that carbamazepine is significantly better than gabapentin
for patients with partial onset seizures 1.
Side effects and tolerability: Gabapentin is better tolerated and produces
significantly fewer untoward cognitive effects compared with carbamazepine
Gabapentin vs. Phenobarbital
The small randomized, open-label study13 compared gabapentin with phenobarbital for reducing symptoms of alcohol withdrawal. In the study the proportion of patients needing “rescue” phenobarbital for breakthrough signs and symptoms of withdrawal did not significantly differ between treatment groups (57% of the gabapentin group vs. 38% of the phenobarbital group). The proportion of those who failed to complete the trial also did not significantly differ between the groups.
There were no significant differences in withdrawal symptoms
or psychological distress, nor were there serious adverse events.
These findings suggest that gabapentin may be as effective as phenobarbital in the treatment of alcohol withdrawal.
Gabapentin vs. Topiramate (Topamax)
Side effects: Gabapentin is better tolerated than topiramate16. Weight loss and numbness are common with topiramate. Dizziness, weight gain and somnolence are more common with gabapentin.
Unlike gabapentin, topiramate has demonstrated risk of teratogenicity9.
Topiramate has prominent negative effects on cognition, whereas gabapentin has only
minimal impact on cognitive abilities 6.
Both drugs are effective in migraine prophylaxis. Topiramate works slightly more efficaciously than gabapentin.
|Results of comparative randomized open label control trial of topiramate and gabapentin in migraine prophylaxis16
|Reduction in mean monthly migraine frequency
||from 11.97 +/- 4.452 to 2.73 +/- 2.59
||from 10.67 +/- 4.25 to 1.82 +/- 2.02
|Reduction in severity
||from 6.93 +/- 1.90 to 1.18 +/- 1.01
||from 6.60 +/- 2.122 to 1.03 +/- 0.92
|Reduction in the average duration of attacks
||from 22.20 +/- 20.72 to 1.08 +/- 1.40 hours
||from 25.77 +/- 22.32 hours to 1.05 +/- 1.06 hours
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Published: March 31, 2008
Last updated: July 31, 2014