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Guillain-Barre Syndrome


 


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Medication for GBS

Have Meds or experiences with Meds you would like to add to this page????  E-mail me and I will add them here to share with others.

 

The following article was published in the Fall/Winter 2001 edition of THE COMMUNICATOR  A Fact Sheet on GBS for the General Practitioner/Primary Care Physician by Joel S. Steinberg, MD, PhD

These are followed by Pain: Weakness is the major feature of GBS. However, many patients also experience some degree of paresthesias (abnormal sensations), such as numbness, tingling, formications (a sense of insects crawling under the skin) and even pain. These may be felt in the feet, hands, and elsewhere. They may become more prominent when the patient is fatigued. Of the various paresthesias that the GBS patient may experience, pain is the most problematic and thus usually merits treatment. Several options may be tried. Treatment should be customized.
 

(I) Over the counter analgesics usually offer a safe initial approach to pain relief. Choices include acetaminophen (Tylenol); aspirin or ASA, including formulations to reduce the risk of upset stomach (enteric coated aspirin [Ecotrin], aspirin with antacid (Ascriptin); ibuprofen (Advil) and naproxen (Aleve). In addition, other non-prescription approaches, such as moist heat or cold applications may be considered.

Of prescription drugs, the following products are sometimes helpful to relieve pain. The more popular medications, in part reflective of results of formal studies are bolded.

(II) Prescription analgesics. Several drugs are available in this group. These include propoxyphene (e.g. Darvocet N-100), tramadol (Ultram; Ultracet), non-steroidal anti-inflammatory drugs (NSAID's), pentazocine (Talwin Compound [with aspirin]) [watch for dependence], opioids, the local analgesic lidocaine, applied as a 5% patch (Lidoderm) and topically applied capsaicin (applied to the skin up to 4 times a day). Long acting analgesics, such as fentanyl (Duragesic Patch), a narcotic analgesic, may reduce the risk of addiction. As a generalization, opioids may not be that helpful for neuropathic pain. Furthermore, a potential for addiction and constipation may limit their practical use. The latter may be addressed with sufficient dosing of senna concentrate (e.g. Senokot tablets) or lactulose syrup, to obtain a comfortable daily bowel movement.

(III) Tricyclic antidepressants are attractive in part due to low cost, as they are available generically. An example is nortriptyline (Pamelor). It can be started at a low dose, 10mg q. h.s., and doubled every few days to weeks, as tolerated, until pain is reduced or side effects become too annoying (dry mouth, etc.) A maximal dose is 150mg. Other tricyclic antidepressants, e.g., amitriptyline (Elavil, Endep), desipramine (Norpramine, Pertofrane) and doxepin (Sinequan), a dibenzoxepin, may also be considered. Nortriptyline and other tricyclics can be combined with the anti-seizure medications described below.

(IV) Selective serotonin uptake inhibitors (SSUI). Among this class of antidepressants, paroxetine (Paxil) has been used to suppress pain.

(V) Anticonvulsants. Several drugs originally developed and marketed to treat seizures (anticonvulsant or antiseizure drugs) have become popular to suppress pain. Historically phenytoin (Dilantin) and carbamazepine (Tegretol) had been found helpful to reduce pain. However, untoward side effects have led to a preference for newer, safer antiseizure medications.

1. Gabapentin (Neurontin) (available as 100, 300, 400, 600 and 800mg capsules) is perhaps the most popular medication in the anticonvulsant group. It can be started at a low dose, of 100mg a day, and doubled, every 4-7 days, in a bid to tid regimen, to doses as high as 4,000mg total daily, until pain abates. If dizziness, somnolence or other side effects develop, decease to the prior dose for 1-2 weeks, until side effects abate. Other potential anticonvulsant options are listed below.

2. Topiramate (Topamax) (available as 25, 100 and 200mg tablets) is typically started at 25-50mg and increased, every 1-2 weeks, as a bid regimen, to total daily doses of 50 (as 25mg bid) to 400mg (200mg bid) dosing. If drowsiness or weight loss develop, decrease the dose for 2 to 4 weeks until side effects abate.

3. Lamotrigine (Lamictal), another antiseizure medication (available in 25, 100, 150 and 200mg tablets) should be started at a very low dose, 25mg every other day, to reduce the risk of severe skin rash. It can be increased, every other week, to two times a day, and then doubled every other week, up to 250mg twice a day. At least one study (Aakrzewska, Pain73:223; 1997) supports its potential ability to relieve pain.

4. Zonisamide (Zonegran: 100mg capsule) is a newer anticonvulsant agent. Initially started at 100mg daily, the dose is increased after a steady state is achieved at two weeks (due to its long half life), at 100mg increments, to 200 and even 400mg daily. Potential side effects include somnolence, anorexia, dizziness, headache, nausea and agitation/irritability. Formal study evidence for pain reduction capability iw wanting.

5. Oxcarbazepine (trileptal: 150, 300 and 600mg tablets) also a newer anticonvulsant agent, is reported to have efficacy comparable to Tegretol. It is usually started at 300mg bid and increased as may be warranted, at weekly intervals, to 600mg bid and then to 1200mg bid. Potential side effects include headache, somnolence or fatigue, dizziness, viral infection, nausea and asymptomatic hyponatremia.

6. Valproic acid (Depakene: 250mg capsule, Depakote) is a carboxylic acid type of anticonvulsant that has been used to suppress pain. The recommended dosing for seizures is 15mg/kg/day (1,000mg for a 70kg [150 lb] patient, and can be increased every week by 5-10mg/kg/day (about 250-500mg/70kg), to a servative dosing has been recommended, starting at 500mg per day, and increased by 100mg per week. Various studies suggest its value to relieve pain. A potential for liver toxicity warrants monitoring of hepatic function during the first six months of use.

7. Clonazepam (Klonopin, 0.5, 1, 2mg tablets), in the benzodiazepine group of anticonvulsants (along with chlordiazepoxide [Librium], etc.), has helped suppress pain in a small percentage of patients. Divided day doses, raised slowly up to 3mg total per day are usually tolerated, and a daily dose as high as 8mg have been successfully used. Potential side effects, drowsiness, fatigue and lethargy, tend to subside with continued use.

(VI) Cardiac antidysmythmia agents. Some drugs, marketed for cardiac dysmythmias (arrhythmias), have sometimes been used to treat pain. An example is mexiletine (Mexitil).

Non-medication treatments. In addition to medications, several other methods have been employed to relieve pain. These include acupuncture, pool therapy, transcutaneous electric nerve stimulation and nerve blocks. As is true for most aspects of medicine, treatment approaches should be individualized for each patient.

Submitted to me by Jethro 10 Jan 03

 

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This page was last modified: January 06, 2006