MedifocusHealth

• • dizziness
  • nausea/vomiting
  • confusion
  • blurred vision
  • fatigue
  • liver dysfunction
  • leucopenia (reduction in the number of white blood cells)

• Oxcarbazepine (Trileptal) is an analog of carbamazepine and is usually better tolerated. This drug is used for the treatment of epilepsy. Limited data from small trials indicate that it may improve pain scores for people suffering from diabetic neuropathy.

• Phenytoin (Dilantin) is an anticonvulsant drug that is used for the treatment of epilepsy. Phenytoin is usually not used as a first line medication for peripheral neuropathy since results from studies are inconsistent. There are some indications that it may be more effective when given intravenously for painful neuropathies. Phenytoin also inhibits insulin production which could be problematic for diabetic patients.

• Topiramate (Topamax) is an anticonvulsant medication that has been reported to be effective in relieving pain associated with various neuropathies, including diabetic neuropathy, in case reports and small clinical trials

Antiarrhythmic Drugs

• Mexiletine - Some studies indicate that mexiletine (Mexitil) is effective for painful diabetic neuropathy but results from other studies are conflicting. Side effects may include:

  • nausea/vomiting
  • dizziness
  • tremor
  • headache
  • abnormal liver function

Narcotic Analgesics

• Oxycodone - This drug is a narcotic and, therefore, carries a high risk of drug dependence. Oxycodone is effective for some types of neuralgia (e.g., postherpetic neuralgia) but data is limited regarding sensory neuropathy. The controlled release form of oxycodone has shown promising results for diabetic neuropathy, with significant improvement in pain levels and sleep quality. The extended-release formulation of oxycodone is preferred for long-term therapy. Doses are titrated slowly until pain relief is achieved. Higher doses of oxycodone yield significant results for some patients with peripheral neuropathy, however, they are also associated with more adverse effects. Side-effects are common and include:

  • nausea/vomiting
  • decreased appetite
  • constipation
  • dry mouth
  • dizziness
  • fatigue
  • increased sweating
  • decreased sex drive
  • muscle twitches
  • seizures
  • changes in breathing
  • allergic reactions

Oxycodone is contraindicated in people with a history of drug/alcohol abuse or patients with chronic obstructive pulmonary disease.

• Levorphanol - Limited data indicates modest pain relief for some types of neuropathic pain (less effective for sensory neuropathy than for other types such as postherpetic neuralgia) but side effects occur frequently and include:

  • itching
  • mood swings
  • confusion
  • weakness

Non-Narcotic Analgesics

• Tramadol (Ultram) - This drug has properties of narcotics but does not bind to opioid receptors so is less likely to cause dependence or abuse. It has been in use in the United States since 1995. Limited trials indicate that its effect is similar to TCAs or levorphanol for diabetic and other types of neuropathies. Pain relief was significant and overall health and quality of life scores improved. Small studies indicated that this effect may still be seen after 6 months. Some studies reported improvement in spontaneous pain, touch-evoked pain, and allodynia. Tramadol appears to be better tolerated than TCAs. Adverse effects are frequent, mild, and considered tolerable. They include:

  • nausea
  • constipation
  • headache or dizziness
  • somnolence (fatigue, sleepiness)
  • insomnia
  • loss of appetite
  • blurred vision

It is contraindicated for people with hypersensitivity to opiates, a history of alcohol or drug use, or liver/kidney disease. In a small number of people, more serious side effects may occur including seizures, severe skin rash, shallow breathing, or weak pulse.