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  1. 1

    Ian Haywood

    This is not strictly correct: tricyclics have no PBS restrictions. However they are stupidly ancient medications with multiple problems including potentially fatal arrhythmias and have no advantage over duloxetine/venlafaxine.

  2. 2

    Jon Hunt

    I am not sure how being ancient also means stupid. It’s not their fault. From australian prescriber: “Clinical experience would suggest that antidepressants are often very helpful, especially in cases of peripheral neuropathic pain” “Evidence for the use of other antidepressants apart from tricyclics is very limited. Venlafaxine may be useful” and finally The number of patients who need to be treated with gabapentin for one to have a 50% reduction in pain has been calculated as five.
    Ref: Aust Prescr 2006;29:72-5

  3. 3

    Jon Hunt

    But having said that I’m not sure what the therapeutic guidelines would suggest.

  4. 4

    Mick Vagg

    The generally accepted NNT for gabapentin, pregabalin and amitriptyline is 3.8, 4.2 and 2.9 respectively (Analgesic Guidelines revised edition July 2009). Quilici et al (BMC Neurol. 2009 Feb 10;9:6) concluded from their meta-analysis that gabapentin, pregabalin and duloxetine all had equivalent efficacy when compared from published trials.

    Gabapentin has been off-patent for several years, but none of the generic manufacturers have applied for neuropathic pain approval, presumably as it was not given to the original Neurontin brand.

    I think that for a complex and difficult diagnosis Dr Dowden would agree that even a minority of patients benefiting from appropriate treatment is better than none at all, which is the current situation.


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