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Old 11-21-2011, 11:11 AM #1
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Arrow DRUGS (RX) ~~ Used for Treating Peripheral Neuropathy:

This is just a huge subject. There are primarily two ways PN may be "treated".

1) Most of the people with PN can only be helped palliatively. This means by reducing symptoms of pain, burning and numbness.

2) The second way is by using agents to modify the disease process. IVIG and Rituxan are examples of this. Also if the PN is secondary to autoimmune issues, reducing autoimmune antibodies may modify the disease process in some patients.
Those agents are classed as autoimmune drugs, which suppress antibody production in the body.

3) Patients with hereditary PN, do not have treatments yet other than symptom reduction types.

This is an old list of treatments I made years ago. It does not include supplements, because we have a separate thread now on this forum for that: statements in red are added today by me.
Quote:
Drugs for PN...

AEDs (anti-seizure drugs)

Tegretol/Trileptal both drugs are cousins and similar in action
Dilantin (phenytoin)
Topamax --hard to tolerate
Zonegran
Lamictal
Neurontin/Lyrica
Keppra
Gabatril


Prescription Vitamin preparations

Mentax (the newest and best--- methylfolate, P5P, and methylcobalamin)
Folgard RX--
also Deplin which is high dose methylfolate


Antidepressants-- a partial listing

Elavil (amitriptyline)-- a tricyclic
Pamelor (nortriptyline)-- a tricyclic
Prozac, Lexapro, Celexa, Zoloft, Paxil --- SSRIs
Effexor, Cymbalta -- some norepinephrine reuptake actions
Desyrel (trazadone) mostly for sleep issues

Opiates--this is a partial list

Oxycodone (Oxycontin,Percocet)
Morphine (Avinza, MsContin, Kadian)
Duragesic patches (fentanyl)
Vicodin, Lortab Norco (hydrocodone with tylenol)
Codeine (Tylenol with Codeine)
Methadone
Dilaudid (hydromorphone)
BuTran patches -- buprenorphine

NonOpiates for pain relief

Darvon/Darvocet --FDA removed this from sale in US.
Talwin/Talacen
NSAIDs (Ibuprofen, naproxen, Celebrex, Indocin)
Tylenol
Ultram (tramadol)
AlkaSeltzer (with aspirin)

Anti-diabetic drugs for diabetes type I, insulin resistance, and type II diabetes--
There are many more new drugs used for type II now, and also basal insulins injected are now used. I won't list them all here.

examples
Metformin (Glucophage)
Actos
Avandia
Glypizide
Glyburide
Prandin

Benzodiazepines (AntiAnxiety/muscle relaxant)

Klonopin (clonazepam)
Xanax (alprazolam)
Ativan (lorazepam)
Valium (diazepam) Valium and Klonopin are the most commonly used for muscle issues/ and also have some anti-seizure effects

Topical agents

Lidoderm patches-- these are very nice if placed properly
Lidocaine ointment
Emla cream (now called LMX 5%)-- some numbing agents are OTC as well.

compounded ointments with Ketamine/clonidine/ketoprofen/gabapentin etc

Biofreeze (OTC)(this is very cooling, and also anti-inflammatory)--there is a new product by BenGay without the ilex called Cold Therapy with 5% menthol
These work because they contain menthol, which stimulates cold receptors and blocks burning sensations from nerves.

Capsacin cream (most people cannot tolerate the burning from this, but others like it)
The new RX patch Qutenza is capsasin in 8% concentration and requires medical supervision for application

Muscle relaxants (non benzo)

Flexeril (cyclobenzaprine)-- most commonly tried--Amrix is a new delayed release of this
Soma (carisoprol)-- abusable--but some people find it useful
Robaxin -- old timer not used much anymore
Norflex (orphenadrine)
Skelaxin-- very sedating, and often used for resistant patients who don't respond well
Baclofen (Lioresal)--mostly for spasticity issues

Dopamine agonists (for restless legs/movement disorder)

Mirapex
Sinemet
Requip

Misc:
Stadol nasal-- very abusable no longer available
levothyroxine--T4 (for thyroid replacement-- if low), liothyronine (T3)
antihistamines for skin burning (Benadryl/Claritin/Zyrtec/Atarax/Allegra)Allegra, Zyrtec, Benadryl and Claritin are OTC now.
Singulair (leukotriene B4 antagonist for allergic issues)

Also some people are receiving infusions of Lidocaine which may be helpful, and also ketamine...but the RSD patients usually use the ketamine today.

And immune suppressing or disease modifying drugs:

IVIG
Rituxan
Imuran
Cellcept
Prednisone/methylprednisolone
methotrexate
Lefunomide -- this agent is fairly toxic and there are studies showing it actually causes PN... use with caution and care.
and others may be tried in autoimmune cases.
This thread will deal with the treatments by group and the next thread will start with the AED... anti-seizure drugs. These can block signals being passed on by nerves from reaching the brain.
I found some technical explanations for some of the drugs, which may be helpful in the post for those taking them.

edit: quick link to amitriptyline and nerve growth factors:
http://neurotalk.psychcentral.com/sh...=amitriptyline
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Last edited by mrsD; 11-09-2012 at 05:37 PM.
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Old 11-22-2011, 10:14 PM #2
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I work with Deplin and just want clarify a few things. Metanx is part of the Pamlab family along with Deplin. Deplin, which is high L-methylfolate, has indication for depression symptoms. Metanx, has the unique indication specific for DPN. Metanx works by addressing the inadequate nutrition which may lead to nerve damage. Please visit the Metanx or Deplin website for more patient information. Hope this helps.
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Old 11-23-2011, 07:27 AM #3
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Thank you David.... we are very very familiar with Metanx.

I only include Deplin here as an RX version of methylfolate since this list is RX examples. People with MTHFR mutation may use Deplin also.

FDA requires an RX category of any folate 1mg or over.
People can purchase methylfolate OTC from the Solgar supplement company at 800mcg/tablet (.8mg).

Folate BTW is not a huge player in PN management. Metanx's
main benefit is the methylcobalamin.
Those with the MTHFR mutation however have higher homocysteine levels and can benefit from Metanx (and folate in general). Some drug treatments deplete folate, and may be used by patients with PN.... methotrexate, NSAIDs, Prednisone, H2 antagonists, HRT, Sulfasalazine, etc.
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Old 11-28-2011, 07:31 PM #4
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This is an interesting discussion, but as always consult with your doctor. For eample, Aleve(naproxen) moved me very close to chronic kidney failure.
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Old 11-29-2011, 07:42 AM #5
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Quote:
Originally Posted by Robibbie1 View Post
This is an interesting discussion, but as always consult with your doctor. For eample, Aleve(naproxen) moved me very close to chronic kidney failure.
Yes, all the NSAIDs carry risks. In fact all the drugs on this list are risky in some way. NSAIDs also increase the risk of cardiovascular incidents.

This list is not for people to self medicate with....it is to illustrate the various types of medications that may work to relieve some
pain of neuropathy.

As I get time I am going to make individual posts on each group. But the holidays have delayed me somewhat.
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Old 11-29-2011, 02:53 PM #6
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There is one more disease modifying drug that is very common in autoimmune disease/neuropathies...Plaquenil. It's an anti-malarial used as a DMARD.

It may not actually 'fix' the neuropathy, but it does aid in control/slowing progression of autoimmune disease...therefore possibly indirectly helping the neuropathy.

Maybe I should have waited to comment when you address that particular group. Anyway, I'd be interested in hearing your comments on Plaquenil.
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Old 02-28-2013, 08:30 PM #7
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Default Valium

I have 5mg valium nightly. Could that be making my NP worse? I am thinking of asking my GP for some anti depressants but not sure which ones as I also am on coumdin
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Old 03-01-2013, 02:45 AM #8
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Quote:
Originally Posted by dazle View Post
I have 5mg valium nightly. Could that be making my NP worse? I am thinking of asking my GP for some anti depressants but not sure which ones as I also am on coumdin
SSRIs affect bleeding times, and are not recommended for
patients on blood thinners.

And yes, Benzodiazepines may make neuropathy worse.
What do you take the Valium for?
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Old 03-08-2013, 09:08 PM #9
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Default Valium

I suffer with depression and Valium has been helping to keep my demons away. I have read on the internet that anti depressants can also be a treatment for neuropathy. I commenced prisiq 3 days ago and already my feelings of shaking has subsided. I intend to wean myself off the valium but that has to be done slowly I believe.
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Old 11-05-2013, 12:06 PM #10
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Confused Neuropathy from Chemotherapy

Does anyone have any experience with neuropathy from chemotherapy? I want to relieve my friend's pain so bad. She is suffering from neuropathy on her thigh/hip area. I don't know where to start. Her oncologist only seems to treat her cancer (Stage 4 Cervical Cancer that was treated and rid her of the cancer for a short time). She has recurrent cervical cancer right now. She is already on roxicet and oxycontin and that does not help. She said she did get some relief with Xanax. She also was given some marijuana that helped a lot. She is not a usual pot smoker - but she was desperate! Thank you for taking the time to read this. Any help would be appreciated.
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