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PAIN MEDICINE

The Interaction Between Gabapentin and Amitriptyline in the Rat Formalin Test After Systemic Administration

Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada

Address correspondence and reprint requests to Jana Sawynok, Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3H 4H7, Canada. Address e-mail to sawydalu{at}is.dal.ca

We examined the effects of systemically administered gabapentin on flinching and biting/licking behaviors produced by 2.5% formalin in the rat, compared these with those of amitriptyline, and determined the effects of combinations of gabapentin with amitriptyline. Gabapentin produced a dose-related inhibition of Phase 2, but not Phase 1, flinching and biting/licking behaviors. In contrast, amitriptyline produced an increase in Phase 2 flinching behaviors while simultaneously decreasing biting/licking behaviors. Fifty percent effective dose (ED₅₀) values against biting/licking behaviors were 22.9 ± 1.3 mg/kg and 8.5 ± 1.3 mg/kg for gabapentin and amitriptyline, respectively. Combinations of increasing fractional increments of ED₅₀ doses of gabapentin and amitriptyline produced an additive effect against biting/licking behaviors, as revealed by isobolographic analysis. These increments had no effect on flinching behaviors except at the ED₂₅ + ED₂₅ doses, at which flinching was increased, again revealing additivity between the two drugs. Flinching behaviors in rats do not reflect the analgesic properties of systemically administered amitriptyline observed in humans and may not be useful for predicting an effect of combinations of drugs with amitriptyline. Biting/licking behaviors do reflect analgesic properties for both drugs and may be more useful in this regard.

IMPLICATIONS: By use of the rat formalin test, a model of persistent pain, we examined the effect of a combination of amitriptyline and gabapentin, which are used to treat chronic pain in humans. The drug combination produced additive analgesia against one outcome, but another outcome was more ambiguous.