Which medications in the drug class Anticonvulsant are used in the treatment of Diabetic Neuropathy?

Updated: Jan 08, 2019
  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Anticonvulsant

Gabapentin (Neurontin) has been reported to work excellently in the treatment of dysesthetic pain. [103] Carbamazepine (Tegretol, Carbatrol, Epitol) has been used mainly for partial seizures and can be used in peripheral neuropathy as a third-line agent if all other agents fail to reduce or improve symptoms of diabetic neuropathy. Carbamazepine is a potentially effective treatment for chronic neuropathic pain. [106] However, the studies evaluating carbamazepine for chronic neuropathic pain must be interpreted with caution.

Pregabalin (Lyrica) is approved for the treatment of pain due to generalized diabetic peripheral neuropathy and may be considered as a first-line agent in diabetic peripheral neuropathic pain. [107]

In October 2017, the FDA approved Lyrica CR (pregabalin extended-release tablets) for the treatment of diabetic peripheral neuropathy, as well as postherpetic neuralgia. The agency based its approval of the drug, which is taken once daily, on the success of a randomized, placebo-controlled trial involving patients with postherpetic neuralgia, with pain intensity improving by at least 50% in 73.6% of those patients treated with Lyrica CR and in 54.6% of patients in the placebo group. [108]

According to the 2011 American Academy of Neurology (AAN)/American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM)/American Academy of Physical Medicine and Rehabilitation (AAPMR) guideline, lamotrigine (Lamictal) should probably not be recommended for diabetic neuropathy treatment due to relative inefficacy in pain control when compared with placebo. [109]

Gabapentin (Neurontin)

Excellent in treating pain described as dysesthetic, such as burning or pins and needles. Gabapentin should be used after all other first-line measures have been used without relief. This drug is a second-generation anticonvulsant. Gabapentin increases brain GABA levels, binds to the alpha2-delta subunit of voltage-gated calcium channels, and inhibits branched chain amino acid transferase.

Carbamazepine (Tegretol, Carbatrol, Epitol)

AED used mainly in partial seizures. Can be used in peripheral neuropathy as a third-line agent if all other agents fail to reduce or improve symptoms of diabetic neuropathy.

First-generation anticonvulsant. Slows the recovery rate of voltage-gated Na channels, minor Ca2+ channel antagonist effect, and is related chemically to tricyclic antidepressants.

Pregabalin (Lyrica, Lyrica CR)

FDA approved for the treatment of pain due to generalized diabetic peripheral neuropathy. The FDA has also approved the once-daily treatment Lyrica CR (pregabalin extended-release tablets) for the pain of diabetic peripheral neuropathy. Pregabalin is excellent in treating pain described as dysesthetic, such as burning or pins and needles. It may be considered as a first-line agent in diabetic peripheral neuropathic pain. This drug is also a second-generation anticonvulsant. Pregabalin binds to the alpha-2-delta subunit of voltage-gated calcium channels and inhibits branched chain amino acid transferase. This reduces inappropriate calcium influx into a hypersensitized cell.

Phenytoin (Dilantin)

May stabilize neuronal membranes and treat neuralgia by increasing efflux or decreasing influx of sodium ions across cell membranes in motor cortex during generation of nerve impulses. When serum level in or near therapeutic range, adjust dose in 30- to 50-mg increments. Small-dose increments may cause greater than expected increases in serum concentration (ie, Michaelis-Menten drug kinetics). Steady-state serum levels may take up to 3 wk to occur because half-life is concentration dependent.


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