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Vasculitic Neuropathy Medication

  • Author: Abbas Mehdi, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
 
Updated: Feb 05, 2015
 

Medication Summary

Treatment of vasculitic neuropathy is based on the underlying cause of the vasculitis. Not all vasculitic neuropathies are treated with similar protocols.

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Immunosuppressants

Class Summary

These agents are required for nearly all forms of vasculitic neuropathies; however, the choice of different types of immunosuppressants is based on the underlying cause. Similarly, adjust length of treatment and doses accordingly. In severe cases, IV methylprednisolone is recommended as "pulse" therapy.

Prednisone (Sterapred)

 

Immunosuppressant for treatment of autoimmune disorders. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)

 

Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability.

Cyclophosphamide (Cytoxan, Neosar)

 

Chemically related to nitrogen mustards. As alkylating agent, mechanism of action of active metabolites may involve cross-linking of DNA, which may interfere with growth of normal and neoplastic cells. In high doses, affects B cells by inhibiting clonal expansion and suppression of production of immunoglobulins. With long-term low-dose therapy, affects T cell functions.

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Tricyclic antidepressants

Class Summary

Neuropathic pain frequently is seen with axonal degeneration and is secondary to inflammation or ischemia associated with vasculitis and nerve regeneration. Peripheral nerve regeneration is a slow process and may require months after the initial exacerbation or inflammation subsides. Patients may require long-term treatment for neuropathic pain. Use NSAIDs for acute or breakthrough pain; narcotics also are used and are a risk for addiction, especially with the chronicity of the symptoms. TCAs are used as first-line drugs in low doses for chronic or neuropathic pain.

Nortriptyline (Pamelor, Aventyl HCl)

 

Has demonstrated effectiveness in treatment of chronic pain. By inhibiting reuptake of serotonin and/or norepinephrine by presynaptic neuronal membrane, increases synaptic concentration of these neurotransmitters in CNS. Pharmacodynamic effects such as desensitization of adenyl cyclase and down-regulation of beta-adrenergic receptors and serotonin receptors also appear to be involved in mechanisms of action. Patients developing sleep cycle disruption or insomnia can be switched to amitriptyline.

Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain. Patients developing daytime sedation can be switched to nortriptyline.

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Anticonvulsants

Class Summary

Certain antiepileptic drugs have proven helpful in some cases of neuropathic pain.

Carbamazepine (Tegretol)

 

A sodium-channel blocker can provide significant relief of neuropathic pain. Adverse effect profile for older patients is more onerous than with newer anticonvulsants, thereby limiting usefulness in this group. Long-term use must be closely monitored and adjusted by treating physician.

Gabapentin (Neurontin)

 

Can be useful in treatment of neuropathic pain. Often tolerated better than carbamazepine by elderly patients. Can be used in patients with hepatic disease because undergoes renal clearance.

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Nonsteroidal anti-inflammatory agents (NSAIDS)

Class Summary

These agents have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

Ibuprofen (Motrin, Ibuprin)

 

For patients with mild to moderately severe pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Abbas Mehdi, MD Director, MDA Center of Central California; Consulting Staff, Department of Neurology, California Neurological Center, Inc

Abbas Mehdi, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Said R Beydoun, MD Chief, Professor, Department of Neurology, University Hospital, University of Southern California

Said R Beydoun, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Additional Contributors

Norman C Reynolds, Jr, MD Neurologist, Veterans Affairs Medical Center of Milwaukee; Clinical Professor, Medical College of Wisconsin

Norman C Reynolds, Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, International Parkinson and Movement Disorder Society, Sigma Xi, Society for Neuroscience

Disclosure: Nothing to disclose.

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Diagnostic classification of peripheral vasculitic neuropathy (PVN).
 
 
 
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