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Emannuela Santiago De ,carvalho - One of the best experts on this subject based on the ideXlab platform.
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Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis
Sociedade Brasileira de Anestesiologia, 2004Co-Authors: Alves, Túlio César Azevedo, Azevedo, Giselli Santos, Emannuela Santiago De ,carvalhoAbstract:JUSTIFICATIVA E OBJETIVOS: A neuralgia do trigêmeo é uma síndrome de dor crônica, caracterizada por paroxismos de dor excruciante que afeta de maneira dramática a qualidade de vida dos pacientes acometidos. A terapia medicamentosa sistêmica é considerada o tratamento de primeira linha para esta doença. Este estudo teve como objetivo avaliar a eficácia, a segurança e a tolerabilidade dos diversos tratamentos farmacológicos oferecidos aos pacientes com neuralgia do trigêmeo, visando fornecer evidências para as recomendações da prática clínica e identificar as necessidades de pesquisas adicionais. MÉTODO: Foram analisados ensaios clínicos aleatórios e controlados, publicados até julho de 2003, sobre o efeito analgésico das drogas prescritas no tratamento da neuralgia do trigêmeo. A análise estatística foi realizada com o auxilio do programa Review Manager 4.2.2 (Colaboração Cochrane, 2003). RESULTADOS: Os resultados da metanálise sugerem que a carbamazepina é mais eficaz que o placebo. Em três estudos controlados comparando a lamotrigina, o topiramato e o cloridrato de proparacaína ao placebo, somente a lamotrigina mostrou-se superior a ele. O dextrometafano foi comparado ao lorazepam em baixas doses, havendo aumento da dor com o uso daquele fármaco. Três estudos compararam a carbamazepina com a tizanidina, a tocainida e a pimozida, mostrando-se apenas a pimozida superior à carbamazepina. CONCLUSÕES: A carbamazepina continua como droga de escolha para o tratamento da neuralgia do trigêmeo, estando a lamotrigina e a pimozida indicadas em casos refratários à terapia convencional. Além disso, estudos adicionais são necessários para o estabelecimento de futuras opções terapêuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients, trying to supply evidences for clinical practice recommendations and to identify the needs for further research. METHODS: Randomized controlled clinical trials on the analgesic effects of drugs prescribed for trigeminal neuralgia were evaluated. All of them were published until July 2003. Statistical analysis was accomplished with the support of Review Manager 4.2.2 software (Cochrane Collaboration, 2003). RESULTS: Metanalisys results suggest that Carbamazepine is more efficient than placebo. In three controlled studies comparing lamotrigine, topiramate and 0.5% proparacaine hydrochloride, only lamotrigine was superior to placebo. Dextromethorphan was compared to low-dose lorazepam, with increased pain with dextromethorphan. Three studies have compared Carbamazepine to tizanidine, tocainide and pimozide, and only pimozide was superior to Carbamazepine. CONCLUSIONS: Carbamazepine is still the drug of choice for treating trigeminal neuralgia, being lamotrigine and pimozide indicated for cases refractory to conventional therapy. In addition, further studies are needed to determine future therapeutic options.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del trigémino es una síndrome de dolor crónico, caracterizada por paroxismos de dolor excruciante que afecta de manera dramática la calidad de vida de los pacientes acometidos. La terapia medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003). RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas
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Tratamento famacológico da neuralgia do trigêmeo: revisão sistemática e metanálise Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis Pharmacological treatment of trigeminal neuralgia: systematic review and met
Sociedade Brasileira de Anestesiologia, 2004Co-Authors: Túlio César Azevedo Alves, Giselli Santos Azevedo, Emannuela Santiago De ,carvalhoAbstract:JUSTIFICATIVA E OBJETIVOS: A neuralgia do trigêmeo é uma síndrome de dor crônica, caracterizada por paroxismos de dor excruciante que afeta de maneira dramática a qualidade de vida dos pacientes acometidos. A terapia medicamentosa sistêmica é considerada o tratamento de primeira linha para esta doença. Este estudo teve como objetivo avaliar a eficácia, a segurança e a tolerabilidade dos diversos tratamentos farmacológicos oferecidos aos pacientes com neuralgia do trigêmeo, visando fornecer evidências para as recomendações da prática clínica e identificar as necessidades de pesquisas adicionais. MÉTODO: Foram analisados ensaios clínicos aleatórios e controlados, publicados até julho de 2003, sobre o efeito analgésico das drogas prescritas no tratamento da neuralgia do trigêmeo. A análise estatística foi realizada com o auxilio do programa Review Manager 4.2.2 (Colaboração Cochrane, 2003). RESULTADOS: Os resultados da metanálise sugerem que a carbamazepina é mais eficaz que o placebo. Em três estudos controlados comparando a lamotrigina, o topiramato e o cloridrato de proparacaína ao placebo, somente a lamotrigina mostrou-se superior a ele. O dextrometafano foi comparado ao lorazepam em baixas doses, havendo aumento da dor com o uso daquele fármaco. Três estudos compararam a carbamazepina com a tizanidina, a tocainida e a pimozida, mostrando-se apenas a pimozida superior à carbamazepina. CONCLUSÕES: A carbamazepina continua como droga de escolha para o tratamento da neuralgia do trigêmeo, estando a lamotrigina e a pimozida indicadas em casos refratários à terapia convencional. Além disso, estudos adicionais são necessários para o estabelecimento de futuras opções terapêuticas.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del trigémino es una síndrome de dolor crónico, caracterizada por paroxismos de dolor excruciante que afecta de manera dramática la calidad de vida de los pacientes acometidos. La terapia medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003). RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients, trying to supply evidences for clinical practice recommendations and to identify the needs for further research. METHODS: Randomized controlled clinical trials on the analgesic effects of drugs prescribed for trigeminal neuralgia were evaluated. All of them were published until July 2003. Statistical analysis was accomplished with the support of Review Manager 4.2.2 software (Cochrane Collaboration, 2003). RESULTS: Metanalisys results suggest that Carbamazepine is more efficient than placebo. In three controlled studies comparing lamotrigine, topiramate and 0.5% proparacaine hydrochloride, only lamotrigine was superior to placebo. Dextromethorphan was compared to low-dose lorazepam, with increased pain with dextromethorphan. Three studies have compared Carbamazepine to tizanidine, tocainide and pimozide, and only pimozide was superior to Carbamazepine. CONCLUSIONS: Carbamazepine is still the drug of choice for treating trigeminal neuralgia, being lamotrigine and pimozide indicated for cases refractory to conventional therapy. In addition, further studies are needed to determine future therapeutic options
Ziad Hussein - One of the best experts on this subject based on the ideXlab platform.
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simulation of changes in steady state plasma concentrations of perampanel following discontinuation of the enzyme inducing antiepileptic drug eiaed Carbamazepine p3 235
Neurology, 2017Co-Authors: Edgar Schuck, Jim Ferry, Bhaskar Rege, Barry E Gidal, Ziad HusseinAbstract:Objective: To simulate changes in steady-state plasma concentrations of perampanel following discontinuation of concomitant Carbamazepine; to investigate perampanel dose alterations to maintain pre-discontinuation steady-state concentrations. Background: Perampanel plasma concentrations decline 2–3-fold following co-administration of EIAEDs, such as Carbamazepine. Concentrations are expected to increase upon discontinuation of EIAEDs, although the time course to achieve a new steady state has not been established. Design/Methods: A physiologically based pharmacokinetic (PBPK) model for perampanel was developed in Simcyp® version 15.1. Predicted perampanel plasma concentrations from single- and multiple-dose simulations (1–8 mg), and from co-administration simulations with daily Carbamazepine 300 mg BID, were compared with actual data from four Phase I studies in healthy adults. Two Carbamazepine co-administration discontinuation scenarios were simulated: an abrupt discontinuation and a weekly 75 mg down-titration. Down-titration of perampanel (from 8 to 4 mg QD) following abrupt Carbamazepine discontinuation was simulated to investigate dose alterations required to maintain pre-discontinuation steady-state concentrations. Results: The PBPK model accurately reproduced perampanel plasma concentration-time profiles from clinical studies in simulations of single- and multiple-dose regimens and with Carbamazepine co-administration, supporting its use for simulations following Carbamazepine discontinuation. Following simulated abrupt Carbamazepine discontinuation, the return of perampanel concentrations to pre-induced levels took >20 days. Following simulated Carbamazepine down-titration, the rise in perampanel concentrations took approximately 60 days. By down-titrating perampanel at the time of abrupt Carbamazepine discontinuation, steady-state perampanel concentrations were found to remain similar during and after the discontinuation. Conclusions: Steady-state PBPK simulations of perampanel with the EIAED Carbamazepine reproduced decreases in perampanel plasma concentrations from formal drug-drug interactions studies. Perampanel concentrations increase slowly following abrupt discontinuation of Carbamazepine dosing; the rate of increase is slower following down-titration of Carbamazepine versus abrupt discontinuation. Maintenance of perampanel concentrations after Carbamazepine discontinuation may be achieved with down-titration of perampanel dose. Study Supported by: Eisai Inc. Disclosure: Dr. Schuck has received personal compensation for activities with Eisai Inc. as an employee. Dr. Ferry has received personal compensation for activities with Eisai Inc. as an employee. Dr. Rege has received personal compensation for activities with Eisai as an employee. Dr. Gidal has received personal compensation for activities with UCB, Eisai, and Sunovion for speaking engagements. Dr. Gidal has received personal compensation from UCB, Eisai, Sunovion, Upsher-Smith, Lundbeck LLC, and SK-Bioscience as a consultant. Dr. Hussein has received personal compensation for activities with Eisai Ltd as an employee.
Alves, Túlio César Azevedo - One of the best experts on this subject based on the ideXlab platform.
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Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis
Sociedade Brasileira de Anestesiologia, 2004Co-Authors: Alves, Túlio César Azevedo, Azevedo, Giselli Santos, Emannuela Santiago De ,carvalhoAbstract:JUSTIFICATIVA E OBJETIVOS: A neuralgia do trigêmeo é uma síndrome de dor crônica, caracterizada por paroxismos de dor excruciante que afeta de maneira dramática a qualidade de vida dos pacientes acometidos. A terapia medicamentosa sistêmica é considerada o tratamento de primeira linha para esta doença. Este estudo teve como objetivo avaliar a eficácia, a segurança e a tolerabilidade dos diversos tratamentos farmacológicos oferecidos aos pacientes com neuralgia do trigêmeo, visando fornecer evidências para as recomendações da prática clínica e identificar as necessidades de pesquisas adicionais. MÉTODO: Foram analisados ensaios clínicos aleatórios e controlados, publicados até julho de 2003, sobre o efeito analgésico das drogas prescritas no tratamento da neuralgia do trigêmeo. A análise estatística foi realizada com o auxilio do programa Review Manager 4.2.2 (Colaboração Cochrane, 2003). RESULTADOS: Os resultados da metanálise sugerem que a carbamazepina é mais eficaz que o placebo. Em três estudos controlados comparando a lamotrigina, o topiramato e o cloridrato de proparacaína ao placebo, somente a lamotrigina mostrou-se superior a ele. O dextrometafano foi comparado ao lorazepam em baixas doses, havendo aumento da dor com o uso daquele fármaco. Três estudos compararam a carbamazepina com a tizanidina, a tocainida e a pimozida, mostrando-se apenas a pimozida superior à carbamazepina. CONCLUSÕES: A carbamazepina continua como droga de escolha para o tratamento da neuralgia do trigêmeo, estando a lamotrigina e a pimozida indicadas em casos refratários à terapia convencional. Além disso, estudos adicionais são necessários para o estabelecimento de futuras opções terapêuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients, trying to supply evidences for clinical practice recommendations and to identify the needs for further research. METHODS: Randomized controlled clinical trials on the analgesic effects of drugs prescribed for trigeminal neuralgia were evaluated. All of them were published until July 2003. Statistical analysis was accomplished with the support of Review Manager 4.2.2 software (Cochrane Collaboration, 2003). RESULTS: Metanalisys results suggest that Carbamazepine is more efficient than placebo. In three controlled studies comparing lamotrigine, topiramate and 0.5% proparacaine hydrochloride, only lamotrigine was superior to placebo. Dextromethorphan was compared to low-dose lorazepam, with increased pain with dextromethorphan. Three studies have compared Carbamazepine to tizanidine, tocainide and pimozide, and only pimozide was superior to Carbamazepine. CONCLUSIONS: Carbamazepine is still the drug of choice for treating trigeminal neuralgia, being lamotrigine and pimozide indicated for cases refractory to conventional therapy. In addition, further studies are needed to determine future therapeutic options.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del trigémino es una síndrome de dolor crónico, caracterizada por paroxismos de dolor excruciante que afecta de manera dramática la calidad de vida de los pacientes acometidos. La terapia medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003). RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas
Edgar Schuck - One of the best experts on this subject based on the ideXlab platform.
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simulation of changes in steady state plasma concentrations of perampanel following discontinuation of the enzyme inducing antiepileptic drug eiaed Carbamazepine p3 235
Neurology, 2017Co-Authors: Edgar Schuck, Jim Ferry, Bhaskar Rege, Barry E Gidal, Ziad HusseinAbstract:Objective: To simulate changes in steady-state plasma concentrations of perampanel following discontinuation of concomitant Carbamazepine; to investigate perampanel dose alterations to maintain pre-discontinuation steady-state concentrations. Background: Perampanel plasma concentrations decline 2–3-fold following co-administration of EIAEDs, such as Carbamazepine. Concentrations are expected to increase upon discontinuation of EIAEDs, although the time course to achieve a new steady state has not been established. Design/Methods: A physiologically based pharmacokinetic (PBPK) model for perampanel was developed in Simcyp® version 15.1. Predicted perampanel plasma concentrations from single- and multiple-dose simulations (1–8 mg), and from co-administration simulations with daily Carbamazepine 300 mg BID, were compared with actual data from four Phase I studies in healthy adults. Two Carbamazepine co-administration discontinuation scenarios were simulated: an abrupt discontinuation and a weekly 75 mg down-titration. Down-titration of perampanel (from 8 to 4 mg QD) following abrupt Carbamazepine discontinuation was simulated to investigate dose alterations required to maintain pre-discontinuation steady-state concentrations. Results: The PBPK model accurately reproduced perampanel plasma concentration-time profiles from clinical studies in simulations of single- and multiple-dose regimens and with Carbamazepine co-administration, supporting its use for simulations following Carbamazepine discontinuation. Following simulated abrupt Carbamazepine discontinuation, the return of perampanel concentrations to pre-induced levels took >20 days. Following simulated Carbamazepine down-titration, the rise in perampanel concentrations took approximately 60 days. By down-titrating perampanel at the time of abrupt Carbamazepine discontinuation, steady-state perampanel concentrations were found to remain similar during and after the discontinuation. Conclusions: Steady-state PBPK simulations of perampanel with the EIAED Carbamazepine reproduced decreases in perampanel plasma concentrations from formal drug-drug interactions studies. Perampanel concentrations increase slowly following abrupt discontinuation of Carbamazepine dosing; the rate of increase is slower following down-titration of Carbamazepine versus abrupt discontinuation. Maintenance of perampanel concentrations after Carbamazepine discontinuation may be achieved with down-titration of perampanel dose. Study Supported by: Eisai Inc. Disclosure: Dr. Schuck has received personal compensation for activities with Eisai Inc. as an employee. Dr. Ferry has received personal compensation for activities with Eisai Inc. as an employee. Dr. Rege has received personal compensation for activities with Eisai as an employee. Dr. Gidal has received personal compensation for activities with UCB, Eisai, and Sunovion for speaking engagements. Dr. Gidal has received personal compensation from UCB, Eisai, Sunovion, Upsher-Smith, Lundbeck LLC, and SK-Bioscience as a consultant. Dr. Hussein has received personal compensation for activities with Eisai Ltd as an employee.
Túlio César Azevedo Alves - One of the best experts on this subject based on the ideXlab platform.
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Tratamento famacológico da neuralgia do trigêmeo: revisão sistemática e metanálise Tratamiento famacológico de la neuralgia del trigémino: revisión sistemática y metanálisis Pharmacological treatment of trigeminal neuralgia: systematic review and met
Sociedade Brasileira de Anestesiologia, 2004Co-Authors: Túlio César Azevedo Alves, Giselli Santos Azevedo, Emannuela Santiago De ,carvalhoAbstract:JUSTIFICATIVA E OBJETIVOS: A neuralgia do trigêmeo é uma síndrome de dor crônica, caracterizada por paroxismos de dor excruciante que afeta de maneira dramática a qualidade de vida dos pacientes acometidos. A terapia medicamentosa sistêmica é considerada o tratamento de primeira linha para esta doença. Este estudo teve como objetivo avaliar a eficácia, a segurança e a tolerabilidade dos diversos tratamentos farmacológicos oferecidos aos pacientes com neuralgia do trigêmeo, visando fornecer evidências para as recomendações da prática clínica e identificar as necessidades de pesquisas adicionais. MÉTODO: Foram analisados ensaios clínicos aleatórios e controlados, publicados até julho de 2003, sobre o efeito analgésico das drogas prescritas no tratamento da neuralgia do trigêmeo. A análise estatística foi realizada com o auxilio do programa Review Manager 4.2.2 (Colaboração Cochrane, 2003). RESULTADOS: Os resultados da metanálise sugerem que a carbamazepina é mais eficaz que o placebo. Em três estudos controlados comparando a lamotrigina, o topiramato e o cloridrato de proparacaína ao placebo, somente a lamotrigina mostrou-se superior a ele. O dextrometafano foi comparado ao lorazepam em baixas doses, havendo aumento da dor com o uso daquele fármaco. Três estudos compararam a carbamazepina com a tizanidina, a tocainida e a pimozida, mostrando-se apenas a pimozida superior à carbamazepina. CONCLUSÕES: A carbamazepina continua como droga de escolha para o tratamento da neuralgia do trigêmeo, estando a lamotrigina e a pimozida indicadas em casos refratários à terapia convencional. Além disso, estudos adicionais são necessários para o estabelecimento de futuras opções terapêuticas.JUSTIFICATIVA Y OBJETIVOS: La neuralgia del trigémino es una síndrome de dolor crónico, caracterizada por paroxismos de dolor excruciante que afecta de manera dramática la calidad de vida de los pacientes acometidos. La terapia medicamentosa sistémica es considerada como el tratamiento de primera línea para esta enfermedad. El objetivo de este estudio fue de evaluar la eficacia, la seguridad y la tolerabilidad de los diversos tratamientos farmacológicos ofrecidos a los pacientes con neuralgia del trigémino, con la finalidad de suministrar evidencias para las recomendaciones de la práctica clínica e identificar las necesidades de pesquisas adicionales. MÉTODO: Fueron analizados ensayos clínicos aleatorios y controlados, publicados hasta julio de 2003, sobre el efecto analgésico de las drogas prescritas en el tratamiento de la neuralgia del trigémino. El análisis estadístico fue realizado con el auxilio del programa Review Manager 4.2.2 (Colaboración Cochrane, 2003). RESULTADOS: Los resultados de la metanálisis sugieren que la carbamazepina es más eficaz que el placebo. En tres estudios controlados comparando la lamotrigina, el topiramato y el cloridrato de proparacaína al placebo, solamente la lamotrigina se mostró superior a él. El dextrometafano fue comparado al lorazepam en dosis bajas, habiendo aumento del dolor con el uso de aquel fármaco. Tres estudios compararon la carbamazepina con la tizanidina, la tocainida y la pimozida, mostrándose apenas la pimozida superior a la carbamazepina. CONCLUSIONES: La carbamazepina continúa como droga de elección para el tratamiento de la neuralgia del trigémino, estando la lamotrigina y la pimozida indicadas en casos refractarios a la terapia convencional. Además, estudios adicionales son necesarios para que se establezcan futuras opciones terapéuticas.BACKGROUND AND OBJECTIVES: Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients, trying to supply evidences for clinical practice recommendations and to identify the needs for further research. METHODS: Randomized controlled clinical trials on the analgesic effects of drugs prescribed for trigeminal neuralgia were evaluated. All of them were published until July 2003. Statistical analysis was accomplished with the support of Review Manager 4.2.2 software (Cochrane Collaboration, 2003). RESULTS: Metanalisys results suggest that Carbamazepine is more efficient than placebo. In three controlled studies comparing lamotrigine, topiramate and 0.5% proparacaine hydrochloride, only lamotrigine was superior to placebo. Dextromethorphan was compared to low-dose lorazepam, with increased pain with dextromethorphan. Three studies have compared Carbamazepine to tizanidine, tocainide and pimozide, and only pimozide was superior to Carbamazepine. CONCLUSIONS: Carbamazepine is still the drug of choice for treating trigeminal neuralgia, being lamotrigine and pimozide indicated for cases refractory to conventional therapy. In addition, further studies are needed to determine future therapeutic options