Gabapentin monotherapy

Frye, M.A., Ketter, T.A., Kimbrell, T.A., Dunn, R.T., Speer, A.M., Osuch, E.A., Luckenbaugh, D.A., Cora-Ocatelli, G., Leverich, G.S., and Post, R.M. (2000) A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders./ Clin Psychopharmacol 20 607-614. 

Frye MA, Ketter TA, Kimbrell TA, et al A placebo-controlled study of la-motrigine and gabapentin monotherapy in refractory mood disorders. J Clin Psychopharmacol 20 607-614, 2000... 

A 35-year-old woman with epilepsy without a history of psychiatric disorders developed elevated mood after being stabilized on gabapentin monotherapy (3200 mg/ day). After 5 months she developed a manic episode, which remitted when gabapentin was withdrawn. 

Anonymous. Gabapentin monotherapy new indication. Sometimes helpful. Prescrire Int 2000 9(46) 40-2. 

Gabapentin monotherapy was better than placebo in post-amputation phantom limb pain after 6 weeks. There were no significant differences in mood, sleep interference, or activities of daily living. 

Observational studies In an open study in 75 patients with chemotherapy-induced neuropathic pain, gabapentin monotherapy 800 mg/day caused mild somnolence in about 25%, but none stopped taking the drug [106 =]. 

Tsavaris N, Kopterides P, Kosmas C, Efthymiou A, Skopelitis H, Dimitrakopoulos A, Pagouni E, Pikazis D, Zis PV, Koufos C. Gabapentin monotherapy for the treatment of chemotherapy-induced neuropathic pain a pilot study. Pain Med 2008 9(8) 1209-16. 

For maintenance treatment, failure of first-line mood stabilizers or second-line atypical antipsychotics to control symptoms adequately may lead to monotherapy trials with other anticonvulsants such as carbamazepine, lamotrigine, gabapentin, and topiramate (third-line monotherapy). 

Brodie MJ, Chadwick DW, Anhut H, Otte A, Messmer SL, Maton S, Sauermann W, Murray G, Garofalo EA Gabapentin Study Group 945-212. Gabapentin versus lamotrigine monotherapy a double-blind comparison in newly diagnosed epilepsy. Epilepsia 2002 43(9) 993-1000. 

B Place in Therapy. Gabapentin is a second-line agent for patients with partial seizures who have failed initial treatment. In addition, although monotherapy trials have no proven efficacy in previously diagnosed refractory patients, there may be a role for this drug in patients with less severe seizure disorders, such as new-onset partial epilepsy, particularly in the elderly patient. Gabapentin also has been shown to be useful in the treatment of chronic pain and other nonepUepsy conditions. 

The place in therapy of the newer anticonvulsants, such as gabapentin, levetiracetam, tiagabine, topiramate, and zon-isamide, is controversial. Many clinicians consider these agents to be less effective than established mood stabilizers based on initial studies and avoid them for monotherapy in bipolar disorder. 

Gabapentin is absorbed after oral administration and is not metabolized in humans. It is not bound to plasma proteins. It is excreted unchanged, mainly in the urine. Its half-life, when it is used as monotherapy, is 4 to 6 hours. It has no known interactions with other antiseizure drugs. 

---