Gabapentin versus nortriptyline in post-herpetic neuralgia patients: a randomized, double-blind clinical trial--the GONIP Trial

Int J Clin Pharmacol Ther. 2006 Aug;44(8):358-63. doi: 10.5414/cpp44358.


Background: Gabapentin and nortriptyline have not been compared in a randomized trial in post-herpetic neuralgia (PHN). The present study was, therefore, undertaken to determine their comparative efficacy and tolerability in the treatment of post-herpetic neuralgia.

Patients and methods: The study was a randomized, double-blind, parallel-group trial of 9 weeks duration. Adult PHN patients with history of > 8 weeks of PHN pain after healing of rash, a pain intensity of at least 40 mm on a 100 mm visual analog scale at screening and at randomization, and average pain score of at least 4 on the Likert scale during the baseline week were included in the study. Gabapentin and nortriptyline were given in incremental doses at 2-weekly intervals till a maximum tolerated dose was obtained. The primary efficacy parameter was change in pain score (11-point Likert scale) from baseline to the end of the study period.

Results: 70 patients were available for intention-to-treat analysis. The average pain scores on the Likert scale were significantly reduced at the end of study in both the treatment groups with 47.6% and 42.8% reduction in pain scores in nortriptyline and gabapentin groups, respectively. Patients showed significant improvement in sleep scores in both the treatment groups nortriptyline (46.0%) and gabapentin (52.0%). The VAS and the SF-MPQ scores for pain were significantly reduced in both the groups. Gabapentin was, however, better tolerated as compared to nortriptyline.

Conclusion: Gabapentin was shown to be equally efficacious but was better tolerated compared to nortriptyline and can be considered a suitable alternative for the treatment of PHN.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amines / administration & dosage
  • Amines / adverse effects
  • Amines / therapeutic use*
  • Analgesics / administration & dosage
  • Analgesics / adverse effects
  • Analgesics / therapeutic use
  • Capsules
  • Cyclohexanecarboxylic Acids / administration & dosage
  • Cyclohexanecarboxylic Acids / adverse effects
  • Cyclohexanecarboxylic Acids / therapeutic use*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Female
  • Gabapentin
  • Humans
  • Hypotension, Orthostatic / chemically induced
  • Male
  • Middle Aged
  • Neuralgia, Postherpetic / diagnosis
  • Neuralgia, Postherpetic / drug therapy*
  • Neuralgia, Postherpetic / physiopathology
  • Nortriptyline / administration & dosage
  • Nortriptyline / adverse effects
  • Nortriptyline / therapeutic use*
  • Pain Measurement
  • Time Factors
  • Treatment Outcome
  • Urinary Retention / chemically induced
  • Xerostomia / chemically induced
  • gamma-Aminobutyric Acid / administration & dosage
  • gamma-Aminobutyric Acid / adverse effects
  • gamma-Aminobutyric Acid / therapeutic use*


  • Amines
  • Analgesics
  • Capsules
  • Cyclohexanecarboxylic Acids
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Nortriptyline