Amitriptyline, but not lorazepam, relieves postherpetic neuralgia.
In a double-blind, randomized, crossover study, 58 patients with postherpetic neuralgia received 6-week courses of amitriptyline, 12.5 to 150 mg/d; lorazepam, 0.5 to 6 mg/d; or lactose placebo. Doses were titrated to the maximum level tolerated. Patients rated pain in a diary, using lists of verbal descriptors. Forty-seven percent of patients reported moderate or greater relief with amitriptyline, 16% with placebo, and 15% with lorazepam. Mean amitriptyline dose was 65 mg/d. Greater relief was associated with higher amitriptyline doses, up to the maximum dose of 150 mg/d, and with higher serum tricyclic levels. Lorazepam did not relieve pain and was associated with severe depressive reactions in four patients.
Max
M B
MB
Neurobiology and Anesthesiology Branch, National Institute of Dental Research, Bethesda, MD 20892.
Schafer
S C
SC
Culnane
M
M
Smoller
B
B
Dubner
R
R
Gracely
R H
RH
D000328:Adult; D000368:Aged; D000639:Amitriptyline / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010919:Placebos; D011897:Random Allocation
D010919:Placebos; D000639:Amitriptyline; D008140:Lorazepam