Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
Abstract
:1. Introduction
2. Materials and Methods
3. Results and Discussion
3.1. Pharmacotherapy of Diabetic Neuropathy
3.2. Glycemic Control
3.3. Antidepressants
3.4. Anticonvulsants
3.5. Opioids
3.6. Topical Treatment
3.7. Pathogenesis-Oriented Treatment
4. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Pharmacotherapy | FDA Approval for DSPN | Daily Dosage | Untoward Effects | Comments |
---|---|---|---|---|
Antidepressants | ||||
Duloxetine | Yes [23] | 60–120 mg/d [5,17,18,19] | Xerostomia, decreased appetite, somnolence, sweating, gastrointestinal discomfort [22] | Appears to improve the quality of life of patients with painful DSPN [20] |
Amitriptyline | No [33] | 25–100 mg/d [31] | Xerostomia, water retention, increased appetite, weight gain, constipation, vertigo [33] | Appears non-inferior to pregabalin [25], gabapentin, [26] and duloxetin [27] in painful DSPN; monitor QTc interval [33] |
Venlafaxine | No [31] | 75–225 mg/d [31] | Somnolence, dizziness, mild gastrointestinal problems [34] | Evidence of effectiveness for short-term management of painful DSPN [17]; monitor QTc interval [35] |
Anticonvulsants | ||||
Pregabalin | Yes [36] | 150–300 mg/d [36] | Water retention, visual disturbances, somnolence, ataxia, euphoria, vertigo [41] | DSPN-related pain improvement of >30%–50% has been reported [5,17,18,37,38,39] |
Gabapentin | No [47] | 900–3600 mg/d [31] | Somnolence, dizziness, suicidal behaviour, withdrawal-precipitated seizure frequency, multi-organ hypersensitivity [47] | DSPN-related pain relief has been repeatedly reported [26,42,43,44,45,46] |
Opioids | ||||
Tapentadol extended release | Yes [52,53] | 100–500 mg/d [51] | Dizziness, somnolence, headache, fatigue, gastrointestinal problems [51] | Inconclusive pain reduction [5]; addiction concern [32] |
Topical treatment | ||||
Capsaicin cream | No [32] | 0.075% four times/d [31] | Skin-site reactions [63] | Equal efficacy to amitriptyline [62] |
Capsaicin 8% patch | No [68] | One application every 3 months [66] | Skin-site reactions [66] | Conflicting results in DSPN [66]; application can be painful [66]; monitor for transient blood pressure increase for at least one hour following application [66] |
5% lidocaine plaster | No [70] | Maximum 3 lidocaine plasters 5% can be applied to intact skin once daily for a period of 12 h [70] | Skin-site reactions [74] | Comparable efficacy to pregabalin, amitriptyline, capsaicin, and gabapentin [72,73] |
Clonidine gel 0.1% | No [75] | Single doses of 0.65 g of gel, three times daily [76] | Skin-site reactions [76] | Pain relief in a small number of studies of low-to-moderate quality [75] |
Pathogenesis-oriented treatment | ||||
α-Lipoic acid | No [77] | 600–1800 mg orally or 600 mg/d intravenously for 3 weeks, excluding weekends [77,78,79,80,81] | Nausea, vomiting, abdominal discomfort, diarrhea [77] | FDA statement: safe and effective treatment option for painful DSPN [82] |
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Ardeleanu, V.; Toma, A.; Pafili, K.; Papanas, N.; Motofei, I.; Diaconu, C.C.; Rizzo, M.; Pantea Stoian, A. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina 2020, 56, 25. https://doi.org/10.3390/medicina56010025
Ardeleanu V, Toma A, Pafili K, Papanas N, Motofei I, Diaconu CC, Rizzo M, Pantea Stoian A. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina. 2020; 56(1):25. https://doi.org/10.3390/medicina56010025
Chicago/Turabian StyleArdeleanu, Valeriu, Alexandra Toma, Kalliopi Pafili, Nikolaos Papanas, Ion Motofei, Camelia Cristina Diaconu, Manfredi Rizzo, and Anca Pantea Stoian. 2020. "Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review" Medicina 56, no. 1: 25. https://doi.org/10.3390/medicina56010025
APA StyleArdeleanu, V., Toma, A., Pafili, K., Papanas, N., Motofei, I., Diaconu, C. C., Rizzo, M., & Pantea Stoian, A. (2020). Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina, 56(1), 25. https://doi.org/10.3390/medicina56010025