Table 1

Pharmacological treatment options for painful neuropathy

ApproachCompound/measureDose per dayRemarksNNT
Optimal diabetes controlDiet, oral antidiabetic drugs, insulinIndividual adaptationAim: A1C ≤6.5–7%
Pathogenetically oriented treatmentα-Lipoic acid (thioctic acid)*600 mg i.v. infusion 600–1,800 mg orallyDuration: 3 weeks Favorable safety profile6.3 2.8–4.2
First-line symptomatic treatment
    TCAsAmitriptyline(10-)25–150 mgNNMH: 152.1
Desipramine(10-)25–150 mgNNMH: 242.2/3.2
Imipramine(10-)25–150 mgCRR1.3/2.4/3.0
Clomipramine(10-)25–150 mgNNMH: 8.72.1
Nortriptyline(10-)25–150 mgPlus fluphenazine1.2
    Selective serotonin norepinephrine
        reuptake inhibitorsDuloxetine(30-)60–120 mgNNMH (60 mg): 185.3 (60 mg)
NNMH (120 mg): 94.9 (120 mg)
Venlafaxine75–225 mgNNMH (75–225 mg): 216.9 (75–225 mg)
NNMH (150–225 mg): 174.6 (150–225 mg)
    α2-δ ligandsPregabalin(50-)300–600 mgNNMH (300 mg): 236.0 (300 mg)
NNMH (600 mg): 114.0 (600 mg)
Gabapentin(300-)1,800–3,600 mgEvidence weaker than for pregabalin3.8/4.0
Second-line symptomatic treatments
    Local treatmentCapsaicin (0.025%) creamq.i.d. topicallyMaximum duration: 6–8 weeks
    Weak opioidsTramadol50–400 mgNNMH: 7.83.1/4.3
    Strong opioidsOxycodone10–100 mgAdd-on treatment pioid-specific problems2.6
  • *Available only in some countries;

  • †≥50% symptom relief after 3 and 5 weeks;

  • ‡licensed in U.S. and European Union; CRR, concentration-response relationship; NNMH, number needed for major harm.