Duloxetine
Duloxetine and Diabetic Neuropathic Pain
Like several antidepressants in the selective serotonin reuptake inhibitor (SSRI) class, the serotonin and norepinephrine reuptake inhibitor (SNRI) duloxetine is showing promise in the setting of diabetic neuropathic pain. In 3 studies with overlapping investigators, it was found that patients who did not have symptoms of depression obtained significant relief from duloxetine. One study by Wernicke and associates found that 2 different doses, 60 mg daily and 60 mg twice daily, are effective, well tolerated, and do not impair control of diabetes. In an open-label study focused on safety and tolerability. Raskin and colleagues found that the treatment was well tolerated, although statistically significant but clinically unremarkable changes in blood pressure and heart rate were more likely to occur in patients receiving duloxetine. The remaining study also focused on safety and tolerability, and showed that several comorbid conditions common to diabetes, such as hypertension and hypercholesterolemia, did not adversely affect the patients’ ability to tolerate duloxetine.