Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial.
OBJECTIVE (BACKGROUND): Amitriptyline (AT) is a standard therapy for postherpetic neuralgia (PHN). Our hypothesis was that nortriptyline (NT), a noradrenergic metabolite of AT, may be more effective.


METHODS
A randomized, double-blind, crossover trial of AT versus NT was conducted in 33 patients.


RESULTS
Thirty-one patients completed the trial. Twenty-one of 31 (67.7%) had at least a good response to AT or NT, or both. We found no difference with regard to relief of steady, brief, or skin pain by visual analog scales for pain and pain relief; mood; disability; satisfaction; or preference between the two drugs. Intolerable side effects were more common with AT. Most patients (26/33) were not depressed, and most responding showed no change in rating scales for depression despite the occurrence of pain relief.


CONCLUSIONS
We concluded that this study provides a scientific basis for an analgesic action of NT in PHN because pain relief occurred without an antidepressant effect, and that although there were fewer side effects with NT, AT and NT appear to have a similar analgesic action for most individuals.
Etobicoke General Hospital, Canada.
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Watson
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Vernich
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Chipman
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Reed
D000368:Aged; D000639:Amitriptyline / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000009:adverse effects; D018592:Cross-Over Studies; D003863:Depression / Q000209:etiology; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000523:psychology / Q000821:virology*; D009661:Nortriptyline / Q000008:administration & dosage* / Q000009:adverse effects; D010098:Oxycodone / Q000008:administration & dosage; D012890:Sleep
D000701:Analgesics, Opioid; D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D009661:Nortriptyline; D010098:Oxycodone