Gabapentin (Neurontin) versus Other
Gabapentin vs. Pregabalin (Lyrica)
Gabapentin and pregabalin are structurally related compounds. But how do they compare?
As an antiepileptic, pregabalin (Lyrica) 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 shows that pregabalin can provide additional relief and improvement in quality of life in those who did not respond to gabapentin14.
Part of the reason why pregabalin works better is that it has superior pharmacodynamic characteristics15. It has a much higher bioavailability (90% versus 33-66%) and is rapidly absorbed (peak: 1 hr). Also, plasma concentrations increase linearly with increasing dose. This is not true with gabapentin. Gabapentin is slowly absorbed (peak: 3 to 4 hours) and more importantly, plasma concentrations have a non-linear relationship to increasing doses.
Gabapentin vs. Amitriptyline
- Painful diabetic neuropathy:
In an open-label randomized trial gabapentin produced greater improvements
than amitriptyline in pain and paresthesia associated with diabetic
In randomized double-blind study comparing the efficacy of gabapentin
with amitriptyline on diabetic peripheral neuropathy moderate or
greater pain relief was experienced in 11 of 21 patients with gabapentin
and 14 of 21 patients with amitriptyline 4.
- Peripheral neuropathic pain:
In the double blind randomized trial gabapentin was compared in
efficacy and safety with amitriptyline in neuropathic pain treatment
6. Both gabapentin and
amitriptyline provided effective pain control. The degree of pain
improvement and patient satisfaction scale were significantly higher
with gabapentin. Also, gabapentin was more effective especially
in paroxysmal shooting pain than other pain qualities.
- Chronic pelvic pain: Randomized controlled study have shown
that gabapentin alone or in combination with amitriptyline is better
than amitriptyline alone in the treatment of female chronic pelvic
- Side effects and tolerability: Gabapentin appears
to be better tolerated than amitriptyline. Side effects are more frequent
with amitriptyline than with gabapentin 2.
Gabapentin vs. Nortriptyline
- Post-herpetic neuralgia: Gabapentin and nortriptyline ware
compared in a randomized trial in post-herpetic neuralgia (PHN).
Gabapentin appears to be equally effective to nortriptyline 9.
- Side effects and tolerability: Gabapentin is better
tolerated as compared to nortriptyline 9.
Gabapentin vs. Lamotrigine (Lamictal)
- Partial epilepsy:
Unblinded randomised controlled trial have shown that lamotrigine
is significantly better than carbamazepine for patients with partial
onset seizures 1.
Gabapentin and lamotrigine are similarly effective and well tolerated
in patients with newly diagnosed epilepsy 5.
- Mood disorders:
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%;
Gabapentin vs. Carbamazepine
- Partial epilepsy: Unblinded randomised controlled trial
have shown that carbamazepine is significantly better than gabapentin
for patients with partial onset seizures 1.
- Side effects and tolerability: Gabapentin produces
significantly fewer untoward cognitive effects compared with carbamazepine
Gabapentin vs. Bupropion SR
- Smoking cessation:
Gabapentin is less efficacious than bupropion for smoking cessation
but is associated with fewer dropouts from side effects. The
severity of physical discomfort is less with bupropion 7.
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.
Both drugs are effective in migraine prophylaxis. Topiramate works slightly more efficaciously.
In 12-week randomised open label control trial16 reduction of monthly migraine frequency (10.67 +/- 4.25 to 1.82 +/- 2.02) in the topiramate group was greater compared with (11.97 +/- 4.452 to 2.73 +/- 2.59) that in the gabapentin group. Reduction in severity from 6.60 +/- 2.122 to 1.03 +/- 0.92 in the topiramate group was also greater compared with 6.93 +/- 1.90 to 1.18 +/- 1.01 in the gabapentin group. Reduction in the average duration of attacks from 25.77 +/- 22.32 hours to 1.05 +/- 1.06 hours in the topiramate group was greater compared with 22.20 +/- 20.72 to 1.08 +/- 1.40 hours in the gabapentin group.
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Published: March 31, 2008
Last updated: September 25, 2013