| Postherpetic neuralgia

Qutenza vs Gralise

Side-by-side clinical, coverage, and cost comparison for postherpetic neuralgia.

Deep comparison between: Qutenza vs Gralise with Prescriber.AI

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Safety signalsGralise has a higher rate of injection site reactions vs Qutenza based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Gralise but not Qutenza, including UnitedHealthcare

Category

Qutenza

Gralise

At A Glance

RouteTopical

FrequencyEvery 3 months

ClassTRPV1 agonist

RouteOral

FrequencyOnce daily

ClassGABA analogue

Indications

Postherpetic neuralgia
Diabetic Neuropathies

Postherpetic neuralgia

Dosing

Postherpetic neuralgia Single 60-minute application of up to four topical systems; may be repeated every 3 months or as warranted by return of pain.

Diabetic Neuropathies Single 30-minute application on the feet of up to four topical systems; may be repeated every 3 months or as warranted by return of pain.

Postherpetic neuralgia Titrate to 1,800 mg once daily orally with the evening meal over 15 days (300 mg Day 1, 600 mg Day 2, 900 mg Days 3-6, 1,200 mg Days 7-10, 1,500 mg Days 11-14, 1,800 mg Day 15); swallow tablets whole, do not crush, split, or chew; if discontinuing, taper over at least 1 week.

Renal impairment Adjust dose for CrCl 30-60 mL/min (600-1,800 mg once daily); do not use in patients with CrCl <30 mL/min or on hemodialysis.

Contraindications

—

Demonstrated hypersensitivity to gabapentin or any excipient of GRALISE

Drug Interactions

802View drug interactions

997View drug interactions

Adverse Reactions

Most common (>=5%) Application site erythema, application site pain, application site pruritus

Serious Severe irritation due to accidental exposure, application-associated pain, increase in blood pressure, sensory function reduction, severe application site burns

Postmarketing Deep partial-thickness and full-thickness burns and scarring, accidental exposure including eye pain, cough, and eye and throat irritation

Most common (>=1%) Dizziness, somnolence, headache, peripheral edema, diarrhea, dry mouth, nasopharyngitis, weight increased, pain in extremity, back pain, urinary tract infection, constipation, dyspepsia, vertigo, pain, lethargy

Serious Suicidal behavior and ideation, respiratory depression, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/multiorgan hypersensitivity, adverse reactions with abrupt or rapid discontinuation

Postmarketing Angioedema, bullous pemphigoid, erythema multiforme, Stevens-Johnson syndrome, hyponatremia, jaundice, movement disorder, elevated liver function tests, elevated creatine kinase, withdrawal symptoms (seizures, depression, suicidal ideation and behavior, agitation, confusion), life-threatening or fatal respiratory depression (with opioids or CNS depressants)

Pharmacology

Capsaicin is an agonist for the transient receptor potential vanilloid 1 receptor (TRPV1), an ion channel-receptor complex expressed on nociceptive nerve fibers in the skin; topical application causes initial stimulation of TRPV1-expressing cutaneous nociceptors followed by pain relief mediated by reduction in TRPV1-expressing nociceptive nerve endings.

Gabapentin is a GABA analogue whose analgesic mechanism of action is unknown; in animal models it prevents allodynia and hyperalgesia, does not modify GABA receptor binding or GABA metabolism, and is hypothesized to antagonize thrombospondin binding to the alpha-2-delta-1 subunit of voltage-activated calcium channels involved in excitatory synapse formation.

View Full FDA Information

View full FDA information

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Most Common Insurance

Anthem BCBS

Qutenza