NICE guidelines on Diabetic neuropathy

Discussion in 'MRCP Forum' started by samuel, Jan 6, 2014.

  1. samuel

    samuel New Member

    NICE guidelines on Diabetic neuropathy:-

    "Offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain (except trigeminal neuralgia)1.
    If the initial treatment is not effective or is not tolerated, offer one of the remaining 3 drugs, and consider switching again if the second and third drugs tried are also not effective or not tolerated.
    Consider tramadol only if acute rescue therapy is needed (see Treatments that should not be used about long-term use).
    Consider capsaicin cream2 for people with localised neuropathic pain who wish to avoid, or who cannot tolerate, oral treatments.
    1At the time of publication (November 2013), amitriptyline did not have a UK marketing authorisation for this indication, duloxetine is licensed for diabetic peripheral neuropathic pain only, and gabapentin is licensed for peripheral neuropathic pain only, so use for other conditions would be off-label. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the Good practice in prescribing and managing medicines and devices (2013) guidance for doctors for further information.
    2At the time of publication (November 2013), capsaicin cream (Axsain) had a UK marketing authorisation for post-herpetic neuralgia and painful diabetic peripheral polyneuropathy, so use for other conditions would be off-label. The summary of product characteristics states that this should only be used for painful diabetic peripheral polyneuropathy 'under the direct supervision of a hospital consultant who has access to specialist resources'. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the Good practice in prescribing and managing medicines and devices (2013) guidance for doctors for further information."

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