Gabapentin and naproxen
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Gabapentin and Naproxen: A Comprehensive Review
Synergistic Effects in Pain Management
Gabapentin and Naproxen for Antihyperalgesia
Gabapentin, an anticonvulsant, and naproxen, a nonsteroidal anti-inflammatory drug (NSAID), have been studied for their combined effects on pain management. Research indicates that gabapentin and naproxen can interact synergistically to reduce thermal hyperalgesia in animal models of peripheral inflammation. Specifically, combinations of gabapentin and naproxen in fixed-dose ratios (50:1, 10:1, or 1:1) were found to be more effective than either drug alone in reversing thermal hyperalgesia, although they did not significantly reduce paw edema beyond additive effects1.
Clinical Pharmacokinetics of Gabapentin Enacarbil and Naproxen
Gabapentin enacarbil, a prodrug of gabapentin, has been evaluated for potential drug-drug interactions with naproxen. Studies show that co-administration of gabapentin enacarbil with naproxen results in a slight increase in gabapentin's maximum concentration (C_ss,max) and area under the curve (AUC), but these changes are not clinically significant, indicating no need for dose adjustment2.
Comparative Efficacy in Various Pain Conditions
Failed Back Surgery Syndrome
In a randomized controlled trial comparing gabapentin and naproxen for managing pain in patients with failed back surgery syndrome, gabapentin was significantly more effective. Patients receiving gabapentin showed a notable reduction in both back and leg pain compared to those receiving naproxen, with the most significant improvements observed at higher doses of gabapentin3.
Carpal Tunnel Syndrome
A clinical trial assessing the combination of gabapentin and naproxen for carpal tunnel syndrome (CTS) found that the combination therapy significantly improved symptom severity and functional state compared to naproxen alone. This suggests that gabapentin can enhance the efficacy of naproxen in treating CTS4.
Post-Extraction Pain Relief
Studies on post-extraction pain relief after mandibular third molar removal have shown that a combination of gabapentin and naproxen is more effective than naproxen alone. Patients receiving the combination therapy reported significantly lower pain scores at 12 and 24 hours post-extraction5 6.
Chemotherapy-Induced Neuropathic Pain
Gabapentin monotherapy has been found effective in managing chemotherapy-induced neuropathic pain. In a study comparing gabapentin to a combination of naproxen and codeine/paracetamol, gabapentin led to better pain relief, with a significant number of patients experiencing complete or partial pain response7.
Brucellosis-Related Skeletal Pain
In patients with brucellosis, gabapentin was more effective than naproxen in reducing skeletal pain. Significant pain reduction was observed as early as the fourth day of treatment with gabapentin, highlighting its rapid and effective pain control capabilities8.
Chronic Post-Thoracotomy Pain
Gabapentin has also been shown to be effective in treating chronic post-thoracotomy pain. Patients treated with gabapentin reported significant reductions in pain scores compared to those treated with naproxen, with minimal side effects and high patient compliance9.
Multimodal Analgesic Strategies
Trauma Pain Management
In a study comparing two multimodal pain regimens for trauma patients, a regimen including gabapentin and naproxen was found to reduce opioid exposure while providing adequate pain control. This approach highlights the potential of gabapentin and naproxen in multimodal pain management strategies to minimize opioid use10.
Conclusion
The combination of gabapentin and naproxen offers significant advantages in managing various types of pain, from inflammatory and neuropathic pain to post-surgical and trauma-related pain. The synergistic effects of these drugs can enhance pain relief, reduce the need for higher doses, and minimize opioid use, making them a valuable option in pain management protocols.
Sources and full results
Most relevant research papers on this topic
Gabapentin and Pregabalin Can Interact Synergistically with Naproxen to Produce Antihyperalgesia
Gabapentin and pregabalin can interact synergistically or additively to reverse thermal hyperalgesia associated with peripheral inflammation, offering potential therapeutic advantages for chronic inflammatory pain treatment.
Non-RCT
Animal Study
Highly CitedClinical pharmacokinetic drug interaction studies of gabapentin enacarbil, a novel transported prodrug of gabapentin, with naproxen and cimetidine.
No dose adjustment is needed for gabapentin enacarbil when co-administered with naproxen or cimetidine.
Non-RCTGabapentin versus naproxen in the management of failed back surgery syndrome; a randomized controlled trial.
Gabapentin, at a maximum daily dose of 1800 mg, is significantly more efficient than naproxen in treating persistent pain after spinal surgeries.
RCTAnalgesic effect of gabapentin in patients with carpal tunnel syndrome
Combination therapy of gabapentin and naproxen significantly reduced symptom severity and functional state scale in carpal tunnel syndrome patients compared to naproxen alone over a two-month period.
RCTComparison of naproxen and combination therapy (naproxen and gabapentin) in post extraction pain relief.
Combination therapy of naproxen and gabapentin effectively reduces post extraction pain of impacted mandibular third molar compared to naproxen alone.
RCTEfficacy of Naproxen Plus Gabapentin Vs Naproxen Alone in Relieving Post-Extraction Pain of Impacted Mandibular 3rd Molar
Combination therapy of naproxen and gabapentin effectively reduces post extraction pain of impacted mandibular third molars compared to naproxen alone.
RCTGabapentin monotherapy for the treatment of chemotherapy-induced neuropathic pain: a pilot study.
Gabapentin monotherapy is well-tolerated and useful for managing chemotherapy-induced neuropathic pain in cancer patients.
RCTComparison of the Behavioral Changes in Pain Patterns in Brucellosis Patients under Oral Gabapentin and Naproxen Treatment: A Randomized Clinical Trial
Oral gabapentin significantly and rapidly decreases skeletal pain in brucellosis patients, making it an appropriate drug for controlling bone and joint pain.
RCTEffectiveness of gabapentin in the treatment of chronic post-thoracotomy pain.
Gabapentin is a safe and effective treatment for chronic post-thoracotomy pain with minimal side effects and high patient compliance.
Observational StudyHighly CitedMultimodal Analgesic Strategies for Trauma: A Pragmatic Randomized Clinical Trial.
The MAST MMPR effectively reduced opioid exposure after trauma and achieved adequate acute pain control without significantly differing in pain scores.
RCT
Large Human Trial