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Amitriptyline alleviates painful diabetic neuropathy. It is recommended by a variety of guidelines as a first or second-line treatment. [14] It is as effective for this indication as gabapentin or pregabalin but less well tolerated. [29] Amitriptyline is as effective at relieving pain as duloxetine.
Duloxetine, venlafaxine, and amitriptyline are all FDA-approved for chronic musculoskeletal pain, peripheral neuropathy, and fibromyalgia). [ 12 ] [ 13 ] [ 14 ] Examples:
Duloxetine, sold under the brand name Cymbalta among others, [1] is a medication used to treat major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, fibromyalgia, neuropathic pain and central sensitization. [10] [11] It is taken by mouth. [10] Duloxetine is a serotonin–norepinephrine reuptake inhibitor (SNRI ...
Diabetic neuropathy can affect any peripheral nerves including sensory neurons, motor neurons, and the autonomic nervous system. Therefore, diabetic neuropathy has the potential to affect essentially any organ system and can cause a range of symptoms. There are several distinct syndromes based on the organ systems affected. [citation needed]
SNRIs. The most commonly prescribed SNRIs are: Venlafaxine (Effexor XR) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta). Milnacipran (Savella) Levomilnacipran (Fetzima)
Duloxetine has also been associated with cases of liver failure and should not be prescribed to patients with chronic alcohol use or liver disease. Studies have found that Duloxetine can increase liver function tests three times above their upper normal limit. [67] Patients with coronary artery disease should caution the use of SNRIs. [68]
A 2014 meta-analysis from the Cochrane Collaboration found the antidepressant duloxetine to be effective for the treatment of pain resulting from diabetic neuropathy. [66] The same group reviewed data for amitriptyline in the treatment of neuropathic pain and found limited useful randomized clinical trial data.
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