Medication Summary
Treatment of vasculitic neuropathy is based on the underlying cause of the vasculitis. Not all vasculitic neuropathies are treated with similar protocols.
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.
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.
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.
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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Diagnostic classification of peripheral vasculitic neuropathy (PVN).
