Chapter 19 - Gabapentinoids and other anticonvulsants

Summary

Antiepileptic drugs (AED) are often utilized for non-epileptic conditions such as the treatment of neuropathic pain and/or various other medical conditions. Although there is a relative dearth of large multicenter randomized double blind trials of AEDs for neuropathic pain, one of the best studied agents are the gabapentinoids. Gabapentin and pregabalin are often referred to as gabapentinoids or as calcium channel alpha-2-delta ligands. The mechanism of action for each of these is thought to be through their ability, in an excited neuron, to reduce calcium influx into the neuron with subsequent reduction of neurotransmitter release. Gabapentin was initially developed as an adjunctive agent to anticonvulsant therapies. Combining two or more different drugs may improve analgesia, and in some situations, reduce overall adverse effects. In terms of gabapentinoids, the combination of a gabapentinoid and another analgesic agent has been evaluated with promising results.