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• • dizziness
  • fatigue
  • sexual dysfunction
  • dry mouth

• Bupropion (Wellbutrin) - Some studies indicate that this drug diminishes pain by approximately 30% in some individuals. It is considered to be better tolerated than TCAs. The sustained release form of bupropion was the subject of a clinical trial with patients suffering from several types of neuropathic pain. Approximately 70% of the subjects reported significant pain relief after two weeks with a 30% reduction of pain scores as well as improved quality of life measures. Adverse effects may include:

  • restlessness
  • agitation
  • anxiety
  • insomnia
  • skin rash
  • aching muscles
  • frequent urination
  • weight gain or weight loss
  • dry mouth
  • headache/dizziness

For more information about antidepressants for the treatment of peripheral neuropathy, please click on the following link: http://www.medifocus.com/abstracts.php?gid=NR021&ID=15910402

Anticonvulsants

Anticonvulsant drugs inhibit the sodium channels at the cellular level and prevent the spread of abnormal electric discharges. They also are effective in reducing neuropathic pain. Anticonvulsant medications used for peripheral neuropathy include:

• Gabapentin (Neurontin) - This drug is a popular first-line treatment for neuropathic pain although the mode of action of this drug is not clear. Some studies involving patients with diabetic neuropathy show significant improvement in pain scores as well as in secondary outcomes (e.g., mood, sleep disturbances) while other studies did not yield such definitive results. Results for nondiabetic peripheral neuropathy are also not uniformly conclusive. Side effects, most commonly dizziness or drowsiness, are considered to be tolerable and better than for many other medications used to treat peripheral neuropathy. In order to minimize sedation or drowsiness, many patients take the larger portion of their daily dose at night before bedtime.

• Pregabalin (Lyrica) - Pregabalin is a new anticonvulsant drug for peripheral neuropathic pain that was approved by the FDA in August 2005. It is a Schedule V controlled substance meaning that it has accepted medical use and has low potential for abuse relative to certain other drugs, but patients must be carefully monitored to prevent drug dependency and abuse. Pregabalin is closely related in both chemical structure and pharmacological action to gabapentin and is indicated for the treatment of neuropathic pain associated with diabetic neuropathy and for the treatment of neuropathic pain associated with post-herpetic neuralgia. Randomized, controlled clinical trials have shown that pregabalin is safe and effective in decreasing neuropathic pain in patients with diabetic neuropathy and also improved mood, sleep disturbances, and overall quality of life. The most common side-effects experienced by patients in clinical trials who were treated with pregabalin included:

  • dizziness
  • somnolence
  • peripheral edema (swelling of the limbs)
  • weight gain

• Lamotrigine (Lamictal) - Some studies indicate moderate relief for pain related to diabetic neuropathy and HIV-related neuropathy. Side effects are considered minimal and may include:

  • dizziness
  • headache
  • ataxia (loss of coordination)
  • fatigue
  • nausea
  • blurred vision
  • skin rash (mild to severe)

• Carbamazepine (Tegretol) - This drug has been approved by the FDA for the treatment of trigeminal neuralgia. There is limited data regarding its efficacy for the treatment of peripheral neuropathy. Side effects are frequent and can be very pronounced in the elderly. They include: