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Gabapentin and nortriptyline are first-line drugs for neuropathic pain, but each has limited efficacy and dose-limiting side effects. Researchers evaluated whether the drugs, which have different mechanisms of action, might be more effective in combination than as monotherapy.
Canadian researchers randomized 56 patients with painful diabetic polyneuropathy or postherpetic neuralgia to one of three groups; in different sequences, each group received 6 weeks of gabapentin monotherapy (maximum, 1200 mg 3 times daily), nortriptyline monotherapy (maximum, 50 mg twice daily), and combination therapy with both agents. Each treatment period consisted of 24 days of twice-weekly dose titration, 7 days of treatment at the maximum tolerated dose (MTD), …