A board to discuss future MS therapies in early stage (Phase I or II) trials.

Postby dignan » Tue Jul 31, 2007 9:13 am

An abstract about lamotrigine for neuropathic pain:

Double-Blind, Placebo-Controlled Trial of Lamotrigine in Combination with Other Medications for Neuropathic Pain.

J Pain Symptom Manage. 2007 Jul 25
Silver M, Blum D, Grainger J, Hammer AE, Quessy S.
GlaxoSmithKline, Research Triangle Park, North Carolina, USA.

This randomized, double-blind, placebo-controlled study was undertaken to evaluate the efficacy and tolerability of lamotrigine added to gabapentin, a tricyclic antidepressant, or a nonopioid analgesic in patients whose neuropathic pain was inadequately controlled with these medications. Patients with neuropathic pain from diabetic peripheral neuropathy, postherpetic neuralgia, traumatic/surgical nerve injury, incomplete spinal cord injury, trigeminal neuralgia, multiple sclerosis, or HIV-associated peripheral neuropathy, who had a mean weekly pain score >/=4 on an 11-point numerical rating scale, were randomized to receive a flexible dose of lamotrigine 200, 300, or 400mg daily (n=111) or placebo (n=109) for up to 14 weeks (including eight weeks of dose escalation) in addition to their prestudy regimen of gabapentin, a tricyclic antidepressant, or a nonopioid analgesic.

No statistically significant difference in the mean change in pain-intensity score from baseline to Week 14 (primary endpoint) was detected between lamotrigine and placebo (P=0.67). Differences between lamotrigine and placebo were not statistically significant for secondary efficacy assessments, including mean changes from baseline in the Short-Form McGill Pain Questionnaire, the Neuropathic Pain Scale, rescue medication use, and the percentages of patients rated as much improved or very much improved at the end of treatment on the Clinician Global Impression of Change scale and the Patient Global Impression of Change scale.

Lamotrigine was generally well tolerated. Lamotrigine (up to 400mg/day) added to gabapentin, a tricyclic antidepressant, or a nonopioid analgesic did not demonstrate efficacy as an adjunctive treatment of neuropathic pain but was generally safe and well tolerated.

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Postby Tony » Sun Aug 12, 2007 6:38 am

Hello everybody!

The combination with Gabapentin sounds interesting, though two ion channel blockers seem to be quite heavy..

Unfortunately, I tolerated none of them. I started with Gabapentin, it made me tired at a dose of only 100 mg per day. I then tried Pregabalin, it was even worse, tired and dizzy, I had to stop after 2 days.

I then tried Lamotrigine, which I first tolerated well. Having in mind my reactions on the two other drugs, we started at a very low dosage, 5mg per day, increasing it by 10mg per week.

However, I then noticed that my MS symptoms were worsening, quicker than normally and - very unusual - in summertime. I then found out that this has been reported some times and that it should all go away when stopping the drug. So we decided to tapper it down over some days to see what happens (I was at a dosage of 60mg per day at that stage).

I was in fact doing better after two days. What happened then was that while tappering it down, I had a severe skin reaction which needed to be treated with cortisone.. Though this is a known side effect, this normally happens only when increasing the dosage too quickly.

So I think I will not try any ion channel blocker any more! :) Only my potassium channel blocker 4-AP is still of great help!

Best whishes

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Postby Toyoterry » Sun Aug 12, 2007 2:09 pm

I've tried Lamotrigine, Neurontin and now Lyrica in combination with Amytriptilne. I've been on Lyrica and Amytriptilne for almost two years and my neuropathic pain and my MS symptoms have greatly improved. I was dizzy at first on the Lyrica but that has past. I take Lyrica, Amytriptilne and Baclofen at bedtime because of the heavy sedation caused by this combo. Lyrica is a controlled substance so you have to be careful with alcohol. I've had three beers in an evening with no trouble.
My highly unprofessional opinion would be to ask your Dr. about this combo. It seems to work well for me.
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