2013 Clinical Department Information ERMED
Pharmacy and Dug Center -
[ Summary of Management Guidelines of the most common Diabetic Neuropathic Complications]
29-Apr-13 10:20 PM
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. 1234567-
Be active ( exercise regularly ) Maintain normal B.P. Stop Smoking. Keep an ideal BMI. Avoid burns and injuries. Wearing comfortable shoes. Vitamin B complex.
Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 2
29-Apr-13 10:20 PM
Level
Generic Name
Examples of trade drugs ( Egyptian Market )
Notes
[ 1 ] Diabetic Neuropathic Pain A B C D
E
Pregabalin
Lyrica, Kemerica, …. Gabapentin Conventin, gaptin, … Sodium valproate Depakin, convulex, .. Dextromethorphan Tussilar Morphine sulphate Tramadol Oxycodon Topical lidocaine
Case by case For chronic DNP & fibromyalgia In massive cases for deep PDN
In selected cases
[ 2 ] Diabetic Gastro-paresis A
B C
Erythromycin Cisapride Motipride,.. Metoclopramide Motilium,… Poly-Ethylin-Glycol 3350 Tegaserod Tegsoran, zeltrod, ...
In emergent cases & for limited duration due to CV unacceptable events
[ 3 ] Experimental Therapies Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 3
29-Apr-13 10:20 PM
A
Aldose reductase inhibitors :
B
Alerstatin Sorbinil Tolrestat Epralrestat Alpha lipoic acid
C
Actovegin
D
Spinal stimulators
Aren’t currently used in USA market, only used in Japan
Thiotex, thiotacid, ..
As antioxidant Improve DN symptoms & sensory functions
cord
Abbreviations DN: Diabetic Neuropathy B.P: Blood Pressure BMI: Body Mass Index DNP: Diabetic Neuropathic Pain PDN: Painful Diabetic Neuropathy CV: Cardio Vascular
Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 4
29-Apr-13 10:20 PM
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.
Egyptian Railway Medical Center, Clinical Pharmacy & DIC Department 5