Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true?

Abstract

Gabapentin (Neurontin¹) and pregabalin (Lyrica²) are first- and second-generation α2δ ligands, respectively, and are both approved for use as adjunctive therapy in pain control. Although they do not bind to gamma-aminobutyric acid (GABA) receptors they have been successfully used to treat neuropathic pain conditions. Their mechanism of action is not yet fully understood, but research has demonstrated promising results. Despite their similarities, they have been used in combination in both clinical and research situations, and have been noted to have a synergistic effect in pain control without concern for clinically significant pharmacokinetic interactions. This combined approach can be made use of to reduce the dose of an individual agent, its side effects, and to enhance therapeutic response compared to a single agent. Pharmacokinetics, drug interactions, and adverse reaction to combinations have to be taken into consideration before combination therapy with gabapentin and pregabalin is proposed as first-line treatment in refractory pain situations and in patients with low levels of tolerance for an individual agent.

Keywords:

• Gabapentin
• pregabalin
• neuropathic pain
• combination therapy
• pain modulation

Notes

Transparency

Declaration of funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author contributions: Conception and design: H.S.; analysis and interpretation of data: H.S.; drafting of paper and revising it critically: H.S., G.J.; final approval of version to be published: H.S.; accountable for all aspects of the work: H.S., G.J.

Declaration of financial/other relationships

H.S. and G.J. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

H.S. and G.J. thank Michal Moshkovich and Shaira Wignarajah for the excellent editing efforts in preparation of this material.

Notes

1 Neurontin is a registered trade name of Pfizer Inc.

2 Lyrica is a registered trade name of Pfizer Inc.