Choosing Medications For Painful Diabetic Neuropathy

Volume 16 - Issue 7 - July 2003
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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

Author(s):

By Matt Rampetsreiter, DPM, and Raymond Abdo, DPM

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