A new drug combination for trigeminal neuralgia.

A new combination of two old drugs seems to provide relief for some trigeminal neuralgia (TN) sufferers. The first line drugs for TN are epilepsy drugs, carbamazepine (Tegretol) or oxcarbazepine (Trileptal). A presentation at the last annual scientific meeting of the American Headache Society by Saudi physicians described successful use of another epilepsy/pain drug, pregabaline (Lyrica) with an antidepressant/pain drug duloxetine (Cymbalta). Both Lyrica and Cymbalta are approved by the FDA for the treatment of some pain conditions, although not TN. The doctors compared Lyrica alone with Lyrica and Cymbalta in combination in 200 patients. The combination resulted in an 80% reduction of pain, which was observed within 10 days, while Lyrica alone produced a 60% reduction that started within 20 days. The dose of Lyrica was 150 mg twice a day (after a one week build up from 75 mg twice a day) and the dose of Cymbalta was 60 mg a day.

Since both Cymbalta and Lyrica have pain relieving properties, this appears to be a rational combination of medications to use in TN and possibly other painful conditions, including various types of headaches. However, as a general rule, we try to use a single drug whenever possible to reduce the potential for side effects. TN is such a severe and debilitating condition, that it may be justified to use a combination early, especially if the first line drugs, such as oxcarbazepine fail.

In my previous posts I have described the use of intravenous medications, Botox and other invasive treatments for TN.

1 comment
  1. su says: 09/05/20146:47 pm

    Dear Dr. Mauskop,

    I have been using a combination of Oxycontin ER and Lyrica since 4 years now with very good results against TN Type 2 pain. The Lyrica helps with the fine facial nerves, the Oxycontin ER with the teeth and ear pain. However, severe shocks of TN1 can not buffered compltely with it. Right now I have outbreak of TN1 on the other side (the main right side was done MVD surgery last year), and now i take 400mg Tegretol, a very low dose but I donot tolerate more.
    To the superior effect of the Lyrica/Oxycontin ER combination (taken at once), there was an Italian study published on the TNA website under knowledge.

    As for the problem of addiction, I have read a lot of patent complaining that is next t impossible to withdraw from Cymbalta and myself had severe withdrawal symptoms of Lyrica years before in an unrelated condition.

    In addition, for me expensive Zomig or the affordable Sumatritan works when the TN pain gets into the eye.


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