Tricyclic antidepressant use in diabetic neuropathy.
OBJECTIVE
To determine whether all tricyclic antidepressants are equally effective in the treatment of painful diabetic neuropathy.


METHODS
A MEDLINE search for randomized controlled studies was conducted from January 1966 to December 1998.


CONCLUSIONS
Amitriptyline, imipramine, and desipramine are superior to placebo in relieving painful diabetic neuropathy. Desipramine has been shown in one small study to have efficacy equal to amitriptyline. Imipramine has been compared with amitriptyline in another small study, but the lack of statistics and adverse effect evaluation did not allow for critical comparison between the two agents. No randomized studies on nortriptyline monotherapy in diabetic neuropathy have been published. Data are insufficient to determine whether all tricyclic antidepressants are equally effective. Amitriptyline and desipramine are reasonable first choices in treating diabetic neuropathy.
Joss
J D
JD
Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City 52246, USA. jacqueline-joss@uiowa.edu
D000639:Amitriptyline / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D003891:Desipramine / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D006801:Humans
D000929:Antidepressive Agents, Tricyclic; D000639:Amitriptyline; D003891:Desipramine