Amitriptyline in the prevention of chemotherapy-induced neuropathic symptoms.

Background: Neuropathy is a common adverse effect of chemotherapy. The tricyclic antidepressant, amitriptyline, is a gold standard in the treatment of neuropathic pain. This double-blind, randomized placebo-controlled trial assessed the efficacy of amitriptyline to prevent chemotherapy-induced neuropathic symptoms. Patients and Methods: Patients without previous neuropathy, who started chemotherapy with vinca alcaloids, platina derivatives or taxanes, were randomized to receive amitriptyline (target dose, 100 mg daily) or placebo for the duration of their chemotherapy. Chemotherapy-induced neuropathic symptoms were evaluated with a patient diary and after every third chemotherapy cycle with clinical examination. The diary data were transformed to a neuropathy score. A total of 114 patients fulfilling the inclusion criteria were randomly assigned to the treatment or control arm. Results: There was no difference in the appearance of chemotherapy-induced neuropathic symptoms between the groups. In general, the intensity of neuropathic symptoms was mild. Conclusion: Amitriptyline does not prevent chemotherapy-induced neuropathy.