The average dose of pregabalin in the study was 218 mg/day, and the average dose of amitriptyline was 16 mg/day.

Further details were, and we quote:

Only 5% of participants in each treatment group received the maximum dose of either pregabalin or amitriptyline.There was no significant difference between pregabalin and amitriptyline in the main study outcome of pain relief. Overall response rates were 77% for pregabalin and 73% for amitriptyline. Good pain relief was reported among 48% and 34% of users of pregabalin and amitriptyline, respectively, and there was evidence that both study treatments reduced pain within 1 week of the initiation of therapy. Of note, nearly half of participants who had previously received amitriptyline or pregabalin for painful diabetic neuropathy responded to study treatment.

Of all adverse events reported, 65.4% occurred with amitriptyline. The rates of treatment discontinuation because of adverse events were 38.6% and 13.6% in the amitriptyline and pregabalin groups, respectively. Drowsiness was the most common adverse event associated with both study treatments and was more common with amitriptyline vs pregabalin (43% vs 20% of subjects, respectively).

The authors bring into memory the results of a previous study comparing amitriptyline with gabapentin in the same indication. That small trial compared gabapentin at a mean dose of 1565 mg/day to amitriptyline at a mean dose of 59 mg/day.

Moderate or greater pain relief was reported in 52% of participants receiving gabapentin and 67% of subjects receiving amitriptyline, with no significant difference in pain outcomes between randomized groups. Moreover, the overall rate of adverse events was similar in the amitriptyline and gabapentin groups. 

Amitriptyline and pregabeline together: go slow, stay low in the beginning 

Thus we can conclude that both drugs are equal effective, amitriptyline is much cheaper, and after 1 week of treatment the first painstilling effects should be seen.

In our approach in Soest we first try some interventions with less side effects, such as topical creams, certain forms of acupuncture and supplements of proven use in diabetic neuropathic pain, especially since many patients tried all the drugs mentioned above and more with not roo much effect and are wary of the side-effects. However, if we need a second step, we start slow and low, mostly with both drugs,a s they can be combined easily, without any interaction, apart from the pharmacodynamic one of creating drowsiness. 

From the Centre for the study and treatment of neuropathic pain and neuropathy in Soest, the Nertherlands

This site helps patients and treating physicians, neurologists, anesthesiologists and other pain specialists to find the best and most up to date research findings related to neuropathy and neuropathic pain and the treatment thereof.

In our centre we are specialised in treating patients suffering from neuropathic pain and neuropathy following an Integrated Medicine concept. Part of our activities are within the field of consultation. We assist pharmaceutical companies in R&D strategies related to finding new drugs to treat neuropathic pain and neuropathy.

March 2010, Jan M. Keppel Hesselink, MD, PhD.