Uremic Neuropathy Medication

Updated: Aug 27, 2018
  • Author: Yi Pan, MD, PhD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Medication

Medication Summary

Paresthesia symptoms can be treated like other neurogenic pain, with anticonvulsants or antidepressants. See medications listed in Traumatic Peripheral Nerve Lesions. Obviously, the dosing must be adjusted to the renal function or timing of dialysis.

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Tricyclic antidepressants

Class Summary

This complex group of drugs has central and peripheral anticholinergic effects, sedative effects, and central effects on pain transmission. TCAs block active reuptake of norepinephrine and serotonin. Nortriptyline is a TCA but has less anticholinergic effects in neurogenic pain.

Nortriptyline (Pamelor)

Has demonstrated effectiveness in treatment of chronic pain; may increase synaptic concentration of serotonin and/or norepinephrine in CNS by inhibiting presynaptic reuptake. 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.

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Anticonvulsants

Class Summary

These agents are used to manage paresthesia and have central effects on pain modulation. Although carbamazepine and valproic acid are useful in controlling neurogenic pain, gabapentin currently is the most frequently used anticonvulsant.

Gabapentin (Neurontin, Gralise, Fanatrex FusePaq)

Has properties common to other anticonvulsants and has antineuralgic effects; exact mechanism of action not known; structurally related to GABA but does not interact with GABA receptors.

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Local anesthetics

Class Summary

Lidocaine stabilizes neuronal membranes, possibly by inhibiting ionic fluxes required for initiation and conduction of impulses.

Lidocaine anesthetic (Lidoderm, Lidovex, Lidtopic, Xolido, Topicaine, Astero, Glydo, Zingo)

This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. Has relieved intensity of pain in postherpetic neuralgia.

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Antidepressants, Other

Class Summary

The analgesic properties of certain agents in this class may improve symptoms associated with neuropathic pain.

 

Duloxetine (Cymbalta)

Duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake. Has improved neuropathic pain in several randomized, double-blind studies and it is well tolerated. A common initial side effect, nausea, can be curtailed if the drug is started at a low dose of 20 or 30 mg during the first week.

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