Neuropsychiatric Disease and Treatment (Dec 2019)

Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome

  • Suga T,
  • Takenoshita M,
  • Watanabe T,
  • Tu TTH,
  • Mikuzuki L,
  • Hong C,
  • Miura K,
  • Yoshikawa T,
  • Nagamine T,
  • Toyofuku A

Journal volume & issue
Vol. Volume 15
pp. 3599 – 3607

Abstract

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Takayuki Suga,1 Miho Takenoshita,1 Takeshi Watanabe,1 Trang TH Tu,1 Lou Mikuzuki,1 Chaoli Hong,1 Kazuhito Miura,2 Tatsuya Yoshikawa,1 Takahiko Nagamine,3 Akira Toyofuku1 1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Gerodontology, Division of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan; 3Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Yamaguchi, JapanCorrespondence: Akira ToyofukuDepartment of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, JapanTel/Fax +81 3 5803 5898Email [email protected]: To assess the therapeutic dose and safety of amitriptyline and the outcome following treatment with amitriptyline among older patients with burning mouth syndrome (BMS).Methods: 187 consecutive patients were prescribed amitriptyline as a first-line medication from April 2016 to September 2018 and followed-up for >1 month. Patients were divided into 3 groups: group 1, 113 patients aged <65 years; group 2, 52 patients aged between 65 and 74 years; and group 3, 22 patients aged 75 years or older. The visual analog scale (VAS), Pain Catastrophizing Scale (PCS), Somatic Symptom Scale-8 (SSS-8), Patient GlobalImpression of Change (PGIC), and Short-form McGill Pain Questionnaire (SF-MPQ) were used for analysis.Results: Thirty-two patients (17 in group 1, 10 in group 2, and 5 in group 3) stopped taking amitriptyline due to side effects. There were no differences among the groups with respect to sex; scores of VAS, PCS, and SSS-8; and drop-out ratio. There were no significant differences in the VAS, PCS, and PGIC scores among the groups after 1 month. The mean daily dose after 1 month was 20.4 ± 8.6 mg in group 1, 17.3 ± 8.7 mg in group 2, and 13.2 ± 5.8 mg in group 3; this difference was significant (p value = 0.003). About 76% of patients showed improvements in their symptoms (PGIC ≥ 3). About 90% of patients reported side effects. No serious side effects occurred.Conclusion: The therapeutic dose of amitriptyline may be lower for older BMS patients than for younger patients.Keywords: amitriptyline, burning mouth syndrome, aged, chronic pain

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