Gabapentin for Post-Herpetic Neuralgia

Efficacy and Recommendations

Gabapentin is recommended as an effective first-line oral pharmacological treatment for post-herpetic neuralgia (PHN), with a number needed to treat (NNT) of 4.39, according to the Clinical Infectious Diseases guidelines 1
The typical effective dosage ranges from 1800 to 3600 mg per day in divided doses, as recommended by Clinical Infectious Diseases 2

Pregabalin may be considered as an alternative, particularly for patients who have inadequate response to gabapentin, as suggested by Clinical Infectious Diseases 1, 3
Capsaicin 8% dermal patch is recommended as a topical treatment option, providing up to 12 weeks of pain relief with a single 30-minute application, according to Clinical Infectious Diseases 3
Tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered as alternative or adjunctive therapy, as recommended by Clinical Infectious Diseases 2, 3

First-line therapy: Gabapentin titrated to 1800-3600 mg/day in divided doses, as recommended by Clinical Infectious Diseases 2
If inadequate response after 4-8 weeks, consider adding or switching to pregabalin, as suggested by Clinical Infectious Diseases and Ophthalmology 1, 4
For refractory cases, consider SNRIs (duloxetine, venlafaxine) or alpha lipoic acid as adjunctive therapy, as recommended by Clinical Infectious Diseases and Ophthalmology 2, 3, 4