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Duloxetine in the management of diabetic peripheral neuropathic pain

机译：度洛西汀在糖尿病周围神经性疼痛的管理中

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Abstract: Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients.
机译：摘要：糖尿病性神经病最多可影响70％的糖尿病患者，而糖尿病周围神经性疼痛（DPNP）是糖尿病神经病中最常见且最使人衰弱的疾病。 DPNP大大降低了患病患者的生活质量并增加了管理成本。尽管受到DPNP的影响，但治疗仍然很差，四分之一的患者未接受任何治疗，许多患者接受的药物对DPNP的管理几乎没有或没有疗效。度洛西汀是美国食品和药物管理局批准用于DPNP管理的两种药物之一。度洛西汀是一种5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI），经证实可安全，有效且节省成本，每天60 mg的剂量可减轻DPNP症状。不建议对DPNP管理使用大于60毫克/天的度洛西汀剂量，因为它们不再有效且与更多副作用相关;对于这些患者，加普瑞巴林或加巴喷丁可能是有益的。度洛西汀的副作用通常较轻，在SNRI类中很典型，包括恶心，头晕，嗜睡，疲劳，出汗，口干，便秘和腹泻。鉴于其其他适应症，度洛西汀是患有并存抑郁症，焦虑症，纤维肌痛或慢性肌肉骨骼疼痛的患者进行DPNP治疗的特别好的选择。度洛西汀治疗对血糖控制无临床显着影响，并且不会增加糖尿病患者发生心血管事件的风险。但是，患有肝病或严重肾功能不全的患者应避免使用度洛西汀。鉴于其安全性，有效性和耐受性，度洛西汀是许多患者进行DPNP治疗的绝佳选择。

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