Active Ingredients: Gabapentin
Design: Open-labeled pilot study. Methods: Patients were started on gabapentin extended-release and were followed up for 8 weeks.
SSRIs have at best moderate effect e. All trials are for peripheral NeP. Based on clinical experience, it was commented that the combination therapy results in increased effect, but with simultaneous increase in side effects relative to monotherapies.
Although a class effect of opioids is often described, clinical experience shows a difference of effect between the opioids. In theory, the combination could be effective due to different mechanisms of action.
However, neither sodium channel blockers such as lamotrigine nor multiple modes of action drugs such as topiramate have any certain role in the treatment of NeP. Other trials, for example, Irving et al, 21 added capsaicin patches to chronic pain medications, such as anticonvulsants and found also a favorable response.
The advisors gave mixed responses: good and insufficient evidence for localized NeP, which is the indication for patches.
Overall, experience in clinical practice is that cutaneous patches can be combined with all types of oral therapy in patients who are suitable for local treatment. Combination therapy with TCAs Table 3 below presents the rating of the scientific evidence and clinical experience with combinations with TCAs.
Although this combination is sometimes used in clinical practice, the overlapping side effect profile and the risk of serotonin syndrome makes this combination less useful.
This combination imposes a high risk of serotonin syndrome. The scientific evidence is, however, divergent, dependent on the type of NeP. The combination also led to fewer side effects than high-dose monotherapy. The combination of TCAs and opioids is frequently used by the experts.
The Delphi panel agreed that there is insufficient evidence to support a recommendation for the combination of TCAs and other drugs such as fluphenazine.
The combination of TCAs and tramadol CDC rating C was an exception, as it has been used with good clinical experiences by few experts in the panel. The Delphi panel underlines that caution is advised for use of TCA in the elderly because of anticholinergic side effects and cardiotoxicity.