First line symptomatic therapy for painful diabetic neuropathy: A tricyclic antidepressant or gabapentin?

Abstract

Diabetes is a high prevalence disease leading among others to painful diabetic neuropathy (PDN).Tricyclic antidepressants (TCA) were considered as first line therapy for symptomatic pain therapy.While their efficacy is reasonably well established, their adverse drug reaction (ADR) profile limits theirusefulness. Third generation antidepressants like venlafaxine could overcome these limitations but dataconcerning their efficacy are limited. Among clinicians a new therapeutic trend is occurring: gabapentin,a drug initially marketed as an antiepileptic, is becoming increasingly popular as the first line therapy forPDN. Gabapentin is a ligand for the alpha2/delta modulatory subunit of calcium channels, thusdecreasing intracellular calcium availability. Initial data on the effectiveness of gabapentin in PDNindicates an efficacy comparable with secondary amine TCAs. The reason for gabapentin’s popularity isthe benign ADR profile and the lack of relevant drug-drug or drug-food interactions.