Evaluation of the Efficacy of Carbamazepine and Oxcarbazepine in Trigeminal Neuralgia
DOI:
https://doi.org/10.17533/udea.iatreia.341Keywords:
Carbamazepine, Oxcarbazepine, Trigeminal NeuralgiaAbstract
Introduction: Trigeminal neuralgia is characterized by the presence of sudden, intense and repetitive orofacial pain generated in one or more branches of the trigeminal nerve; carbamazepine and oxcarbazepine are the first-line drugs for its treatment.
Objectives: To analyze the most up-to-date evidence on the doses and efficacy of carbamazepine and oxcarbazepine in the treatment of trigeminal neuralgia.
Methods: A narrative review based on a search of articles in PubMed, Scopus, Scielo and Google was conducted. SANRA guidance for narrative reviews was followed.
Results: In the analyzed studies, it is proposed that for the treatment of trigeminal neuralgia, carbamazepine should be used with an initial dose between 200 and 400 mg per day, and a maintenance dose between 300 and 800 mg per day. On the other hand, the initial dose of oxcarbazepine is proposed at 300 mg per day and the maintenance dose between 600 and 1200 mg.
Conclusions: Carbamazepine and oxcarbazepine are the most used first-line drugs to relieve pain in trigeminal neuralgia, and the doses must be individualized, which depends on the patient characteristics and the evolution of the disease to avoid adverse effects.
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References
(1) De la Cruz-Rodríguez R, Sernaque-Roca K, Aguirre-Siancas E. Rol de los Canales de Sodio Voltaje Dependientes en la Fisiopatología de la Neuralgia del Trigémino. Rev Ecuat Neurol [Internet]. 2022;31(3):41–46. https://doi.org/10.46997/revecuatneurol31300041
(2) Puri N, Rathore A, Dharmdeep G, Vairagare S, Prasad BR, Priyadarshini R et al. A Clinical Study on Comparative Evaluation of the Effectiveness of Carbamazepine and Combination of Carbamazepine with Baclofen or Capsaicin in the Management of Trigeminal Neuralgia. Niger J Surg [Internet]. 2018;24(2):95-99. https://doi.org/10.4103/njs.NJS_8_18
(3) Faryabi J, Joolhar M. Treatments’ Outcomes of Patients Suffered from Trigeminal Neuralgia in Kerman, Iran. J Dent [Internet]. 2014;15(3):140-146. Avaiable from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4149897/
(4) Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Lacerda-Leal PR, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol [Internet]. 2020;19(9):784-796. https://doi.org/10.1016/S1474-4422(20)30233-7
(5) Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Pract Neurol [Internet]. 2021;21(5):392-402. https://doi.org/10.1136/practneurol-2020-002782
(6) Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K. Trigeminal Neuralgia. Asian J Neurosurg [Internet]. 2017;12(4):585-597. https://doi.org/10.4103/ajns.AJNS_67_14
(7) Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh) [Internet]. 2015;20(2):107-114. https://doi.org/10.17712/nsj.2015.2.20140501
(8) Yang F, Lin Q, Dong L, Gao X, Zhang S. Efficacy of 8 Different Drug Treatments for Patients With Trigeminal Neuralgia: A Network Meta-analysis. Clin J Pain [Internet]. 2018;34(7):685-690. https://doi.org/10.1097/AJP.0000000000000577
(9) Di Stefano G, Truini A, Cruccu G. Current and Innovative Pharmacological Options to Treat Typical and Atypical Trigeminal Neuralgia. Drugs [Internet]. 2018;78(14):1433-1442. https://doi.org/10.1007/s40265-018-0964-9
(10) Lee JY, Lee GH, Yi SH, Sim WS, Kim BW, Park HJ. Non-Surgical Treatments of Trigeminal Neuralgia from the Perspective of a Pain Physician: A Narrative Review. Biomedicines [Internet]. 2023;11(8):2315. https://doi.org/10.3390/biomedicines11082315
(11) Gambeta E, Chichorro JG, W. Zamponi G. Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments. Mol Pain [Internet]. 2020;16:1744806920901890. https://doi.org/10.1177/1744806920901890
(12) Pergolizzi Jr JV, LeQuang JA, El-Tallawy SN, Wagner M, Ahmed RS, Varrassi G. An update on pharmacotherapy for trigeminal neuralgia. Expert Rev Neurother [Intrenet]. 2024;24(8):773–786. https://doi.org/10.1080/14737175.2024.2365946
(13) Obermann M. Update on the challenges of treating trigeminal neuralgia. Orphan Drugs Res Rev [Internet]. 2015;5:11-17. https://doi.org/10.2147/ODRR.S53046
(14) Zakrzewska JM, Wu N, Lee JYK, Werneburg B, Hoffman D, Liu Y. Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States. Clin J Pain [Internet]. 2018;34(8):691-699. https://doi.org/10.1097/AJP.0000000000000595
(15) Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol [Internet]. 2019;26(6):831-849. https://doi.org/10.1111/ene.13950
(16) Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Res Integr Peer Rev [Internet]. 2019;4(1):5. https://doi.org/10.1186/s41073-019-0064-8
(17) Ferneini EM. Trigeminal Neuralgia. J Oral Maxillofac Surg [Interenet]. 2021;79(11):2370-2371. https://doi.org/10.1016/j.joms.2021.08.001
(18) Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia - diagnosis and treatment. Cephalalgia [Internet]. 2017;37(7):648-657. https://doi.org/10.1177/0333102416687280
(19) Cruccu G. Trigeminal Neuralgia. Continuum (Minneap Minn) [Internet]. 2017;23(2):396–420. https://doi.org/10.1212/CON.0000000000000451
(20) International Headache Society. The International Classification of Headache Disorders, 3.a edición (versión beta). Cephalalgia [Internet]. 2013;33(9):629-808. https://doi.org/10.1177/0333102413485658
(21) Ruscheweyh R, Lutz J, Mehrkens JH. Trigeminusneuralgie. Schmerz [Internet]. 2020;34(6):486-494. https://doi.org/10.1007/s00482-020-00496-4
(22) Araya EI, Claudino RF, Piovesan EJ, Chichorro JG. Trigeminal neuralgia: Basic and clinical aspects. Curr Neuropharmacol [Internet]. 2020;18(2):109-119. https://doi.org/10.2174/1570159X17666191010094350
(23) Di Stefano G, La Cesa S, Truini A, Cruccu G. Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain. J Headache Pain [Internet]. 2014;15(1):34. https://doi.org/10.1186/1129-2377-15-34
(24) Jones MR, Urits I, Ehrhardt KP, Cefalu JN, Kendrick JB, Park DJ, et al. A Comprehensive Review of Trigeminal Neuralgia. Curr Pain Headache Rep [Internet]. 2019;23(10):74. https://doi.org/10.1007/s11916-019-0810-0
(25) Reinert JP, Nuon K, Veronin MA. Carbamazepine, oxcarbazepine, and lacosamide as adjunctive analgesics: a review of the literature. J Pharm Pract Res [Internet]. 2021;51(1):22-26. https://doi.org/10.1002/jppr.1710
(26) Hirsch A, Wanounou M, Perlman A, Hirsh-Raccah B, Muszkat M. The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: A nested case-control study. BMC Pharmacol Toxicol [Internet]. 2020;21(1):47. https://doi.org/10.1186/s40360-020-00425-2
(27) Di Stefano G, Truini A. Pharmacological treatment of trigeminal neuralgia. Expert Rev Neurother [Internet]. 2017;17(10):1003-1011. https://doi.org/10.1080/14737175.2017.1370375
(28) Chen RJ, Ershad M, Dela Cruz M, Mostafa AMT. Carbamazepine Toxicity Masquerading as Complex Febrile Seizures in a Pediatric Patient. Case Rep Emerg Med [Internet]. 2020;2020: e1790310. https://doi.org/10.1155/2020/1790310
(29) Oomens MAEM, Forouzanfar T. Pharmaceutical Management of Trigeminal Neuralgia in the Elderly. Drugs Aging [Internet]. 2015;32(9):717-726. https://doi.org/10.1007/s40266-015-0293-6
(30) Ajura AJ, Lau SH, Nur Suffia S. An observational study of trigeminal neuralgia patients taking carbamazepine during the fasting month of Ramadan. Med J Malaysia [Internet]. 2016;71(6):305-307. https://pubmed.ncbi.nlm.nih.gov/28087952/
(31) Majeed MH, Arooj S, Khokhar MA, Mirza T, Ali AA, Bajwa ZH. Trigeminal Neuralgia: A Clinical Review for the General Physician. Cureus [Internet]. 10(12):e3750. https://doi.org/10.7759/cureus.3750
(32) Marino S, Birnbaum A, Leppik I, Conway JM, Musib LC, Brundage RC, et al. Steady-state Carbamazepine Pharmacokinetics following Oral and Stable-Labeled Intravenous Administration in Epilepsy Patients: Effect of Race and Sex. Clin Pharmacol Ther [Internet]. 2012;91(3):483-488. https://doi.org/10.1038/clpt.2011.251
(33) Ducros A. The medical treatment of trigeminal neuralgia. Douleur Analgésie [Internet]. 2017;30(2):60-63. https://doi.org/10.1007/s11724-017-0490-7
(34) Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord [Internet]. 2010;3(2):107-115. https://doi.org/10.1177/1756285609359317
(35) Punyani SR, Jasuja VR. Trigeminal neuralgia: An insight into the current treatment modalities. J Oral Biol Craniofacial Res [Internet]. 2012;2(3):188-197. https://doi.org/10.1016/j.jobcr.2012.10.002
(36) Tai AX, Nayar VV. Update on Trigeminal Neuralgia. Curr Treat Options Neurol [Internet]. 2019;21(9):42. https://doi.org/10.1007/s11940-019-0583-0
(37) Peterson-Houle GM, AbdelFattah MR, Padilla M, Enciso R. Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses. J Dent Anesth Pain Med [Internet]. 2021;21(5):379-396. https://doi.org/10.17245/jdapm.2021.21.5.379
(38) Obermann M. Recent advances in understanding/managing trigeminal neuralgia. F1000Research [Internet]. 2019;8:F1000. https://doi.org/10.12688/f1000research.16092.1
(39) McMillan R. Trigeminal Neuralgia — A Debilitating Facial Pain. Rev Pain [Internet]. 2011;5(1):26–34. https://doi.org/10.1177/204946371100500105
(40) Reinert JP, Cook EA. Oxcarbazepine-Induced Cutaneous Reaction in a Female of Mexican Ancestry. J Pharm Technol JPT [Internet]. 2019;35(4):179-183. https://doi.org/10.1177/8755122519850477
(41) Xu R, Xie ME, Jackson CM. Trigeminal neuralgia: Current approaches and emerging interventions. J Pain Res [Internet]. 2021;14:3437-3463. https://doi.org/10.2147/JPR.S331036
(42) Khadilkar SV, Patil VA. Medical Management of Trigeminal Neuralgia. Neurol India [Internet]. 2021;69(Suppl):S199-S205. https://doi.org/10.4103/0028-3886.315996
(43) French JA, Baroldi P, Brittain ST, Johnson JK; PROSPER Investigators Study Group. Efficacy and safety of extended-release oxcarbazepine (Oxtellar XRTM) as adjunctive therapy in patients with refractory partial-onset seizures: a randomized controlled trial. Acta Neurol Scand [Internet]. 2014;129(3):143-153. https://doi.org/10.1111/ane.12207
(44) Wang Y, Zhang HN, Niu CH, Gao P, Chen YJ, Peng J, et al. Population pharmacokinetics modeling of oxcarbazepine to characterize drug interactions in Chinese children with epilepsy. Acta Pharmacol Sin [Internet]. 2014;35(10):1342-1350. https://doi.org/10.1038/aps.2014.76
(45) Naderi Y, Rad M, Sadatmoosavi A, Khaleghi E, Khorrami Z, Chamani G, et al. Compared to oxcarbazepine and carbamazepine, botulinum toxin type A is a useful therapeutic option for trigeminal neuralgia symptoms: A systematic review. Clin Exp Dent Res [Internet]. 2024;10(2):e882. https://doi.org/10.1002/cre2.882
(46) Zhang A, Zhang W, Xu H, Guo C, Yuan L, Xu Y, et al. Diabetes mellitus contributes to carbamazepine resistance in patient with trigeminal neuralgia. Neurosurg Rev [Internet]. 2021;44(2):1119-1125. https://doi.org/10.1007/s10143-020-01304-4
(47) Rodrigues C, Chiron C, Rey E, Dulac O, Comets E, Pons G, et al. Population pharmacokinetics of oxcarbazepine and its monohydroxy derivative in epileptic children. Br J Clin Pharmacol [Internet]. 2017;83(12):2695-2708. https://doi.org/10.1111/bcp.13392
(48) Ali A, Anugwom GO, Naqvi W, Saeeduddin MO, Singh R. A Case of Carbamazepine-Induced Acute Pancreatitis: A Rare Etiology. Cureus Reports [Internet]. 2021;13(5):e15199. https://doi.org/10.7759/cureus.15199
(49) Kuroda H, Taniguchi K, Tsukimoto S, Imaizumi U, Komaki M, Sanuki T. Carbamazepine-Induced Systemic Lupus Erythematosus in a Patient With Idiopathic Trigeminal Neuralgia: A Case Report. Cureus [Internet]. 15(10):e47009. https://doi.org/10.7759/cureus.47009
(50) Di Stefano G, De Stefano G, Leone C, Di Lionardo A, Di Pietro G, Sgro E, et al. Real-world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia. Eur J Pain [Internet]. 2021;25(5):1064-1071. https://doi.org/10.1002/ejp.1727
(51) Lee JE, Min KR, Kim SH, Kim AH, Kim ST. Analysis of Adverse Drug Reactions with Carbamazepine and Oxcarbazepine at a Tertiary Care Hospital. Yonsei Med J [Internet]. 2020;61(10):875-879. https://doi.org/10.3349/ymj.2020.61.10.875
(52) Kaya O, Hurel C, Gumussuyu G, Kose O. Bilateral calcaneal insufficiency fractures due to chronic carbamazepine use for trigeminal neuralgia: A case report. Niger J Clin Pract [Internet]. 2020;23(4):574-576. https://doi.org/10.4103/njcp.njcp_515_18
(53) Song HG, Nahm FS. Oxcarbazepine for trigeminal neuralgia may induce lower extremity weakness: A case report. World J Clin Cases [Internet]. 2020;8(5):922-927. https://doi.org/10.12998/wjcc.v8.i5.922
(54) Guo M, Shen W, Zhou M, Song Y, Liu J, Xiong W, et al. Safety and efficacy of carbamazepine in the treatment of trigeminal neuralgia: A metanalysis in biomedicine. Math Biosci Eng [Internet]. 2024;21(4):5335–5359. https://doi.org/10.3934/mbe.2024235
(55) Besi E, Boniface DR, Cregg R, Zakrzewska JM. Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP). J Headache Pain [Internet]. 2015;16:563. https://doi.org/10.1186/s10194-015-0563-z
(56) O’Callaghan L, Floden L, Vinikoor-Imler L, Symonds T, Giblin K, Hartford C, et al. Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England. J Headache Pain [Internet]. 2020;21(1):130. https://doi.org/10.1186/s10194-020-01198-z
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