Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial.

Abstract

Amitriptyline (AT) relieves some patients with postherpetic neuralgia (PHN). Many patients suffer side effects and better therapies are necessary. The aim of this study was to evaluate the efficacy of maprotiline (MT) (noradrenergic) compared to AT (mixed noradrenergic and serotonergic) in this disorder. Thirty-five patients entered a randomized, double-blind, crossover trial of these two agents. We found that MT relieved PHN in many patients but was not as effective as AT. Side effects were troublesome with both agents. Relief of steady pain, brief pain and pain on tactile stimulation occurred. Four groups of responses were identified. Some patients reported relief with both agents, some with neither agent and others with only one of the drugs. Most patients were not depressed and analgesia was observed to occur without change in depression ratings in most patients who responded. This result provides evidence that in some patients AT may act via a selective noradrenergic mechanism in relieving PHN and that individuals may differ in the balance and type of neurotransmitters inhibiting pain. Selective noradrenergic agents may be effective if AT fails.

• Authors: Peter N C Watson, Mary Chipman, Ken Reed, Ramon J Evans, Nicholas Birkett
• Journal: Pain (Pain) Vol. 48 Issue 1 Pg. 29-36 (Jan 1992) ISSN: 0304-3959 [Print] United States
• PMID: 1738571 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Amitriptyline
• Maprotiline

Topics

• Aged
• Aged, 80 and over
• Amitriptyline (adverse effects, blood, therapeutic use)
• Double-Blind Method
• Female
• Herpes Zoster (physiopathology)
• Humans
• Male
• Maprotiline (adverse effects, blood, therapeutic use)
• Middle Aged
• Neuralgia (drug therapy, physiopathology, psychology)
• Pain Measurement
• Sleep (drug effects)