2013

Clinical Pharmacy Department and Dug Information Center - ERMED

[ Summary of Management

Guidelines of the most common

Diabetic Neuropathic Complications]

29-Apr-13 10:20 PM

Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 2

Summary of Management Guidelines of

the most common Diabetic Neuropathic

Complications

Prepared & summarized by Mohammad M. Kamal Nawar (*) Clinical Pharmacist – ERMED

Management should be begin at the initial diagnosis of DM

, because failure to diagnose diabetic polyneuropathy can

lead to serious consequences , including disability and

amputation.

Management pathways

1- Slow progression of neuropathy (mainly: tight and stable

glycemic control).

2- Therapies for symptomatic relief.

Patient education

Develop realistic diet for lowering glucose and minimizing

fluctuations in BGL.

1- Be active ( exercise regularly )

2- Maintain normal B.P.

3- Stop Smoking.

4- Keep an ideal BMI.

5- Avoid burns and injuries.

6- Wearing comfortable shoes.

7- Vitamin B complex.

29-Apr-13 10:20 PM

Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 3

Level Generic Name Examples of trade drugs ( Egyptian Market )

Notes

[ 1 ] Diabetic Neuropathic Pain

A Pregabalin Lyrica, Kemerica, ….

Case by case

B Gabapentin Conventin, gaptin, …

For chronic DNP & fibromyalgia

C Sodium valproate

Depakin, convulex, ..

In massive cases

D Dextromethorphan Tussilar for deep PDN

Morphine sulphate

Tramadol

Oxycodon E Topical lidocaine In selected cases

[ 2 ] Diabetic Gastro-paresis A Erythromycin

Cisapride Motipride,..

Metoclopramide Motilium,…

B Poly-Ethylin-Glycol 3350

C Tegaserod Tegsoran, zeltrod, ...

In emergent cases & for limited duration due to CV unacceptable events

[ 3 ] Experimental Therapies

29-Apr-13 10:20 PM

Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 4

Abbreviations

DN: Diabetic Neuropathy

B.P: Blood Pressure

BMI: Body Mass Index

DNP: Diabetic Neuropathic Pain

PDN: Painful Diabetic Neuropathy

CV: Cardio Vascular

A Aldose reductase inhibitors : Alerstatin Sorbinil Tolrestat Epralrestat

Aren’t currently used in USA market, only used in Japan

B Alpha lipoic acid Thiotex, thiotacid, ..

As antioxidant

C Actovegin Improve DN symptoms & sensory functions

D Spinal cord stimulators

29-Apr-13 10:20 PM

Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 5

References

- Guidelines of American Academy of Neurology (AAN).

- Guidelines of American Academy of Physical Medicine and

Rehabilitation (AANEM).

- Guidelines American Academy of Physical Medicine and

Rehabilitation (AAPMR).

- Guideline for the treatment of painful diabetic neuropathy

(PDN).

(*) For detailed evidenced papers, kindly contact us.