Abstract
Objectives: Antidepressants and anticonvulsants are most commonly prescribed in postherpetic neuralgia (PHN). The aim of the present study was to compare the efficacy and safety of pregabalin and nortriptyline in patients of PHN.
 Methods: The present study was conducted in 48 patients of PHN attending outpatient department of Dermatology, GMC Jammu. After obtaining written consent, the enrolled patients were randomized into two groups, one group was given pregabalin 150 mg orally per day, and other group was treated with nortriptyline 25 mg orally per day and were followed up to 8 weeks. Patients were assessed on numerical rating scale (NRS), Leeds assessment of neuropathic symptoms and signs (LANSS). Safety of the drugs was monitored by adverse drug reactions (ADRs).
 Results: All patients were over 57 years and thoracic dermatome was most affected. Both drugs significantly reduced NRS and LANSS (p<0.0001). However, on comparison pregabalin was found to be better than nortriptyline at 8 weeks on mean NRS (p= 0.0073), LANSS (p=0.0032). Total of six mild ADRs occurred, two in group pregabalin and four in nortriptyline treated group.
 Conclusion: Both pregabalin and nortriptyline were effective in patients of PHN, but pregabalin was found to be better than nortriptyline at 8 weeks. Both drugs were well tolerated, though pregabalin had lesser number of ADRs.
Highlights
Postherpetic neuralgia (PHN) is a painful complication that occurs after herpes zoster infection due to damage of peripheral nerves by the reactivation of the varicella zoster virus
The present prospective, randomized, open label, and parallel trial was conducted in the Department of Pharmacology in collaboration with Department of Dermatology, Government Medical College Jammu to evaluate and compare the efficacy and safety of pregabalin and nortriptyline in PHN patients after taking approval from the Institutional Ethics Committee
Percentage of responders with ≥30% reduction in numerical rating scale (NRS) score was 100% in both the groups and percentage ≥50% reduction in mean NRS score was 95.83% and 65% in pregabalin and nortriptyline group, respectively
Summary
Postherpetic neuralgia (PHN) is a painful complication that occurs after herpes zoster infection due to damage of peripheral nerves by the reactivation of the varicella zoster virus. Pain is constant or intermittent and burning, stabbing, or itching in character and may affect quality of sleep [1]. No treatment can completely prevent PHN, though starting early antiviral drugs within 72 h of onset of skin lesions can be beneficial. Still 20% patients suffer from PHN despite early antiviral treatment [2]. Treatment of PHN involves use of tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors, opioids, anticonvulsants, and intrathecal corticosteroids [3]. TCAs are most frequently used and cause inhibition of reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, desensitization of adenylyl cyclase, and activation of GABA-B receptors [4]. Nortriptyline, a metabolite of amitriptyline is preferred because of its better safety profile
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