Choosing Medications For Painful Diabetic Neuropathy

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What Newer Oral Agents Are Helpful?

Bupropion (Zyban) is a sustained release antidepressant that is most commonly used for smoking cessation. It functions as a specific inhibitor of neuronal norepinephrine reuptake and a weak inhibitor of dopamine reuptake. In one clinical trial, buproprion, taken at dosages of 150 to 300 mg/day, was superior to placebo in producing pain relief.10 The side effects were considered generally mild.

Lamotrigine (Lamictal) is an antiepileptic drug that inhibits glutamate release and blocks sodium channels. It has been used extensively in HIV neuropathy. However, Eisenberg, et. al., found lamotrigine to be efficacious in patients with painful diabetic neuropathy.11 They started patients at a low dose of 25 mg/day and titrated by 25 to 50 mg weekly.

The effective daily dose is usually 200 to 400 mg taken in divided doses twice a day. The most common adverse effects are drowsiness, dizziness and rash.

Gabapentin (Neurontin) does not have any direct effect on GABA-ergic receptors and does not affect GABA uptake or metabolism.
Choosing Medications For Painful Diabetic Neuropathy
By Matt Rampetsreiter, DPM, and Raymond Abdo, DPM

References 1. Ahmed M, Goucke CR. Management Strategies for the Treatment of Neuropathic Pain in the Elderly. Drugs Aging 2002; 12: 929-945. 2. Rull JA, Quibrera R, Gonzales-Millan H, et al. Symptomatic treament of peripheral neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia 1969; 4: 215-218. 3. Bryson HM, Wilde MI. Amitriptyline. A review of its pharmacological properties and therapeutic uses in chronic pain states. Drugs Aging 1996; 6: 459-476. 4. Perruca E. The clinical pharmocokinetics of the new antiepileptic drugs. Epilepsia 1999; 40: S7-S13. 5. Wright JM, Oki JC, Graves IIIL. Mexiletine in the symptomatic treatment of painful diabetic neuropathy. Ann Pharmacother 1997; 31: 29-34. 6. Oskarsson P, Ljunggren JG, Lins PE. Efficacy and safety of mexiletine in the treatment of painful diabetic neuropathy. The Mexiletine Study Group. Diabetes Care 1997; 20: 1594-7. 7. Stracke H, Meyer UE, Schumacher HE, et al. Mexiletine in the treatment of painful diabetic neuropathy. Diabetes Care 1992; 15: 1550-5. 8. Harati Y, Gooch C, Swenson M, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology 1998; 50: 1842-6. 9. Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998; 50: 1837-41. 10. Semenchuk MR, Sherman S, Davis B. Double-blind, randomized trial of buproprion SR for the treatment of neuropathic pain. Neurology 2001; 57: 1583-1588. 11. Eisenberg E, Lurie Y, Braker C, et al. Lamotrigine reduces painful neuropathy: a randomized, controlled study. Neurology 2001; 57: 505-9. 12. Devers A, Galer BS. Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open label study. Clin J Pain 2000; 16: 205-8. 13. Yuen K, Baker NR, Rayman G. Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray. Diabetes Care 2002; 25: 1699-1703. Additional References 14. Backonja MM. Use of anticonvulsants for treatment of neuropathic pain. Neurology 2002; 59: S14-S17. 15. Simmons Z, Feldman EL. Update of diabetic neuropathy. Curr Opin Neurol 2002; 15: 595-603. 16. Mendell JR, Sahenk Z. Painful Sensory Neuropathy. N Eng J Med 2003; 348: 1243-55.

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Anonymoussays: July 4, 2010 at 4:35 pm

Very nice site!

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