TREATING DIABETIC NEUROPATHY

New research has backed up the hypothesis that neuropathic pain in diabetics can be effectively treated using drugs which block the reuptake of noradrenaline. In particular, good results have been obtained with the selective noradrenaline uptake inhibitor, desipramine.

Although diabetic neuropathy is usually treated using amitriptyline, this compound's wide range of pharmacological actions (including inhibition of 5-HT and noradrenaline reuptake and antagonism of muscarinic cholinergic, histamine H1 and alpha-adrenergic receptors) means that treatment is often compromised by adverse reactions. These side effects include sedation, urinary retention and orthostatic hypotension.

The latest studies, published in the New England Journal of Medicine (May 7), compared the effects of amitriptyline with desipramine in 38 patients, and Eli Lilly's 5-HT reuptake inhibitor Prozac (fluoxetine) with placebo in 46 patients. In addition, 57 patients were randomly assigned between the studies as well as to the type of treatment, enabling comparisons of all four treatment regimens to be carried out.