Lower Dose Gabapentin and Imipramine work in Neuropathic Pain

Tested in Cancer Neuropathic pain, Gabapentin 200 mg and Imipramine 10 mg every 12 hours was found to be a superior combination

J Anesth. 2010 Mar 10. [Epub ahead of print]
Low-dose gabapentin as useful adjuvant to opioids for neuropathic cancer pain when combined with low-dose imipramine.
Arai YC, Matsubara T, Shimo K, Suetomi K, Nishihara M, Ushida T, Kobayashi K,
Suzuki C, Kinoshita A, Kondo M, Matsubara S, Hayashi R, Tohyama Y, Nishida K,
Arakawa M. abstract here

Doses tried:

G400-I = Gabaspentin 200 and imipramine 10 twice daily

G400 = Gabapentin 200 by self twice daily

G800 = gabapentin 400 by self twice daily

I = Imipramine 10 mg Twice daily by self

Comment – drowiness was infrequent and mild on the low dose mix but not so for G800. It could be said that one should work up on the gabapentin dose to 1600 – 3600/day but in meantime, the low dose combo rules!

Addendum – Other combinations have been tried and found  useful in animal models:

Eur J Pharmacol. 2010 Feb 25;628(1-3):75-82. Epub 2009 Nov 14.
Analysis of the antinociceptive interactions in two-drug combinations of gabapentin, oxcarbazepine and amitriptyline in streptozotocin-induced diabetic mice.
Tomić MA, Vucković SM, Stepanović-Petrović RM, Micov AM, Ugresić ND, Prostran MS,
Bosković B. abstract here
Amitriptyline : Oxycarbenazepine 1:2 – 1:12 – synergisticAmitriptyline: Gabapentin 1:2 – 1:6 – additive

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