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Practice Therapeutics

Pregabalin and gabapentin for pain

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1315 (Published 28 April 2020) Cite this as: BMJ 2020;369:m1315

Rapid Response:

Re: Pregabalin and gabapentin for pain

Dear Editor,

Colleagues Dr Goodman and Dr Brett correctly comment on the differences of the approved conditions of gabapentinoids across countries. In Australia, pregabalin is indicated for the treatment of neuropathic pain in adults and as adjunctive therapy in adults with partial seizures with or without secondary generalisation (1). While gabapentin is approved in Australia for neuropathic pain and partial seizures including secondarily generalised tonic-clonic seizures, initially as add-on therapy in adults and children age 3 years and above who have not achieved adequate control with standard anti-epileptic drugs (2). The details of these indications were simplified for reporting in Table 1.

Although some guidelines for the management of neuropathic pain (excluding trigeminal neuralgia) recommend pregabalin and gabapentin as first line pharmacotherapy (3,4), specific licencing approval for gabapentinoids by the US Food and Drug Administration (FDA) does not globally encompass all neuropathic pain conditions as highlighted by Goodman and Brett. The FDA approval of pregabalin in the US would be more accurately detailed in Table 1 as “neuropathic pain associated with diabetic peripheral neuropathy, post-herpetic neuralgia…” (5) rather than “neuropathic pain” alone as suggested. FDA approval for gabapentin is for post-herpetic neuralgia in adults (6). These corrections to Table 1 and the visual summary have been forwarded to the editor.

References
1. Therapeutic Goods Administration. LYRICA pregabalin 300mg capsule bottle. 2019. https:
//www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&
docid=3E21B96419C675E0CA2583D900424C4A&agid=(PrintDetailsPublic)&actionid=1.

2. Therapeutic Goods Administration. GABAPENTIN-GA gabapentin 400 mg capsule blister
pack. 2010. https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.
nsf&docid=7B8F66B0802EE9F3CA2577DD00032FC8&agid=(PrintDetailsPublic)&
actionid=1.

3. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in
adults: a systematic review and meta-analysis. Lancet Neurol 2015;14:162-73.

4. National Institute for Health and Care Excellence. Neuropathic pain in adults:
pharmacological management in non-specialist settings. National Institute for Health and
Care Excellence. 2017. http://guidance.nice.org.uk/CG173

5. Pfizer Inc. Lyrica prescribing information. 2011. https://www.accessdata.fda.gov/
drugsatfda_docs/label/2011/021446s026,022488s005lbl.pdf

6. Pfizer Inc. Neurotin prescribing information. 2017. https://www.accessdata.fda.gov/
drugsatfda_docs/label/2017/020235s064_882s047_1129s046lbl.pdf

Competing interests: No competing interests

05 May 2020
Stephanie Mathieson
Research Fellow
Institute for Musculoskeletal Health
Sydney, Australia