Resumo

GONZALEZ-ESCALADA, J. R.. Pregabalin for the management of peripheral neuropathic pain. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.3, pp.169-180. ISSN 1134-8046.

The availability of pregabalin (PGBB), a new drug belonging to the group of neuromodulators with a better pharmacokinetic profile compared to its predecessors and effective for the management of peripheral neuropathic pain, opens up new horizons for the management of these patients. PGBB is a GABA analogue, although it does not bind to its receptors nor it shows gabaergic actions. Analgesic effects of PGBB are due to its binding to the proteic alpha-2-delta subunit of the voltage-dependant calcium channels at the CNS with greater affinity than gabapentin. In several animal pain models, PGBB has shown antihyperalgesic effectiveness and a better antiallodynia profile compared to morphine and amitriptilin; it is quickly absorbed when orally administered, with a 90% bioavailability, a highly predictable and linear pharmacokinetics with low interindividual variability and a long half life. Consequently, it can be administered in two daily doses. PGBB does not bind to plasma proteins and is mainly excreted unaltered in the urine, so its interaction with other drugs is rare. In this review, the results of five studies of postherpetic neuralgia (PHN) were assessed, with a total of 1,034 patients and other six studies in painful diabetic neuropathy (PDN) that included 1,628 patients. In all of them, PGBB administered in doses of at least 150 mg.day^-1 was effective versus placebo in a dose-dependant way in terms of pain relief, improved sleep and improved parameters of quality of life. The most effective dose was 600 mg (p < 0.001 vs. placebo) and, with a flexible dosage, a mean dose of 457 mg.day^-1 was also highly effective (p = 0.002 vs. placebo). Therapeutic doses of PGBB also showed high safety levels, with a low incidence of slight reversible adverse effects. The presence of severe adverse effects was the same as with placebo. In conclusion, PCBB was an effective and safe drug for the management of neuropathic pain in patients with PHN and DNP.

Palavras-chave : Neuromodulators; Antiepileptics; Neuropathic pain; Postherpetic neuralgia; Diabetic neuropathy.

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