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Grand Rounds

Is Gabapentin Effective at Relieving Menopausal Vasomotor Symptoms?

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BACKGROUND AND PURPOSE:

  • Shan et al. (AJOG, 2019) assessed the efficacy and safety of gabapentin (trade name Neurontin) and pregabalin (Lyrica) for the treatment of vasomotor symptoms

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • Multiple databases | WHO clinical trials registry
  • Inclusion criteria
    • RCTs and randomized crossover studies
    • Studies that compared gabapentin and pregabalin among women with menopausal vasomotor symptoms to other treatment modalities including supplements
  • Study design
    • Two independent reviewers assessed bias and extracted data
    • Random-effects models were used for analysis
  • Primary outcomes
    • Reduction in frequency of vasomotor symptoms from baseline | Severity | Duration

RESULTS:

  • 19 RCTs and 2 randomized crossover trials | Total of 3519 participants
    • 6 studies included breast cancer survivors who were on tamoxifen or aromatase inhibitors 
  • Compared to placebo, gabapentin reduced hot flash frequency (low to moderate evidence)
    • After 4 weeks: Mean difference –1.62 (95% CI, –1.98 to –1.26)
    • After 12 weeks: Mean difference –2.77 (95% CI –4.29 to –1.24)
  • Composite score
    • After 4 weeks: standardized mean difference –0.47 (95% CI –0.71 to –0.23)
    • After 12 weeks: standardized mean difference –0.77 (95% CI –1.15 to –0.40)
    • Benefit was seen in both postmenopausal participants and patients with breast cancer
  • Daily gabapentin dosage
    • Range: 300 mg to 2400 mg
    • Subgroup analysis: 900 mg dose did not results in outcomes substantially different from analysis of all ranges of dosages
  • Adverse events
    • Gabapentin group experienced higher risk of
      • Dizziness: Risk ratio (RR) 4.45 (95% CI, 2.50 to 7.94)
      • Somnolence: RR 3.29 (95% CI, 1.97 to 5.48)
  • Compared to other therapies
    • Estrogen was more effective at reducing hot flash frequency than gabapentin
    • No difference seen between gabapentin and antidepressants
    • Data too limited to provide risk analysis for other treatments
  • Pregabalin was only assessed in 2 trials
    • Pregabalin vs placebo |  Pregabalin superior in reducing hot flash frequency and severity scores
    • Pregabalin vs stellate ganglion block in patients with breast cancer | Better outcomes in ganglion block group

CONCLUSION:

  • Gabapentin was found to be superior vs placebo for the relief of vasomotor symptoms, although less effective than estrogen
  • Evidence for pregabalin “was limited yet promising”

Learn More – Primary Sources:

Efficacy and safety of gabapentin and pregabalin in patients with vasomotor symptoms: a systematic review and meta-analysis

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Related ObG Topics:

North American Menopause Society: Hormone Therapy Statement
The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?
Is Gabapentin an Effective First Line Drug for Vulvodynia?
Can Mindfulness Alleviate Menopausal Hot Flashes?

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