TRATAMIENTO DEL DOLOR EN NEUROPATIA DIABETICA

RECOMENDACIÓN FARMACO 1° Linea 2° Linea Topicos otros > 2 estudios controlados randomizados en NP Diabética Duloxetina Oxycodone CR Pregabalina Antidepresivo triciclicos 2° Linea 1 est. controlado randomizado en NP Diabética > 1 en otra NP Dolorosa Carbamazepina Gabapentina Lamotrigina Tramadol Venlafaxina ER Topicos Capsaicina lidocaina otros > 1 en otra NP Dolorosa u otras evidencias Bupropion Citalopram Metadona Peroxetina Fenitoina topiramato

Acido alpha lipoico Oral Treatment With -Lipoic Acid Improves Symptomatic Diabetic Polyneuropathy. The SYDNEY 2 trial Diabetes Care 29:2365-2370, 2006 Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio Sola S, Mir MQ, Cheema FA, Khan-Merchant N, Menon RG, Parthasarathy S, Khan BV: Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study. Circulation 111:343–348, 2005 In the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study, oral administration of 300 mg ALA per day as monotherapy and in combination with irbesartan (150 mg/day) to patients with the metabolic syndrome resulted in a significant increase in endothelium-dependent flow-mediated vasodilation of the brachial artery by 44 and 75%, respectively, compared with placebo treatment after 4 weeks. This effect was accompanied by reductions in plasma levels of interleukin-6 and plasminogen activator-1, suggesting that the drug may improve endothelial dysfunction via anti-inflammatory and antithrombotic mechanisms Nagamatsu M, Nickander KK, Schmelzer JD, Raya A, Wittrock DA, Tritschler HT, Low PA: Lipoic acid improves nerve blood flow, reduces oxidative stress and improves distal nerve conduction in experimental diabetic neuropathy. Diabetes Care 18:1160–1167, 1995

Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials. Sima AA, Calvani M, Mehra M, Amato A; Acetyl-L-Carnitine Study Group. Diabetes Care. 2005 Jan;28(1):89-94. 1000 pacientes 500 – 1000mg/d por 52 semanas Acetyl-L-carnitine in the treatment of diabetic neuropathy. A long-term, randomised, double-blind, placebo-controlled study. De Grandis D, Minardi C. Drugs R D. 2002;3(4):223-31. Benfotiamine in the treatment of diabetic polyneuropathy--a three-week randomized, controlled pilot study (BEDIP study). Haupt E, Ledermann H, Köpcke W. Int J Clin Pharmacol Ther. 2005 Jun;43(6):304. Prodroga vit B1 liposoluble

Antidepresivos triciclicos (TCA) Intolerancia ortostatica TCA Recomendación Contraindicación Glaucoma Agentes de 1° linea Antidepresivos triciclicos (TCA) Intolerancia ortostatica TCA Alteraciones CV/ECG HTA Insuficiencia renal Duloxetine + 30mL/min Insuficiencia hepatocitica duloxetine Falla sistemica Pregabalina, TCA

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