title: Serotonin-norepinephrine reuptake inhibitors for the management of chemotherapy-induced peripheral neuropathy.
abstract: OBJECTIVE
  To review the literature evaluating serotonin-norepinephrine reuptake inhibitors (SNRIs) for chemotherapy-induced peripheral neuropathy (CIPN).
  
  
  METHODS
  A PubMed search (1966-January 2014) was performed using the key terms serotonin-norepinephrine reuptake inhibitor, desvenlafaxine, duloxetine, milnacipran, venlafaxine, chemotherapy, and peripheral neuropathy. Bibliographies of select articles were examined for additional references and abstracts.
  
  
  METHODS
  Case reports and clinical trials published in English and conducted in humans were identified. All reports and trials evaluating a SNRI for the treatment of CIPN were included; 4 case reports, 1 open-label study, and 2 randomized controlled trials were identified for review.
  
  
  RESULTS
  At present, no medications are approved for the treatment for CIPN. Emerging evidence suggests that venlafaxine and duloxetine may be effective for treating CIPN. Results of select trials report that these medications not only decrease pain but also relieve symptoms of numbness and tingling and improve the functional status and quality of life of patients suffering from CIPN.
  
  
  CONCLUSIONS
  Evidence to support venlafaxine and duloxetine for the treatment of CIPN from oxaliplatin- or paclitaxel-based regimens is promising. Unfortunately, direct comparisons between venlafaxine and duloxetine do not exist, so definitive conclusions about which agent is preferred cannot be made. However, the breadth of data with duloxetine is larger, suggesting that it may be prudent to consider duloxetine first when choosing a SNRI for CIPN treatment. More robust trials are needed to establish their optimal place in therapy with regard to patient population, timing of therapy, dosing, and treatment duration.
authors.affiliation: Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA.
authors.forename: May T
authors.initials: MT
authors.lastname: Aziz
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Good
authors.forename: Denise K
authors.initials: DK
authors.lastname: Lowe
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003511:Cyclohexanols / Q000627:therapeutic use; D003521:Cyclopropanes / Q000627:therapeutic use; D000069468:Desvenlafaxine Succinate; D000068736:Duloxetine Hydrochloride; D006801:Humans; D000078764:Milnacipran; D014179:Neurotransmitter Uptake Inhibitors / Q000627:therapeutic use*; D009638:Norepinephrine / Q000378:metabolism; D009944:Organoplatinum Compounds / Q000009:adverse effects; D000077150:Oxaliplatin; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000188:drug therapy*; D012701:Serotonin / Q000378:metabolism; D013876:Thiophenes / Q000627:therapeutic use; D000069470:Venlafaxine Hydrochloride
chemical_list: D000970:Antineoplastic Agents; D003511:Cyclohexanols; D003521:Cyclopropanes; D014179:Neurotransmitter Uptake Inhibitors; D009944:Organoplatinum Compounds; D013876:Thiophenes; D000077150:Oxaliplatin; D012701:Serotonin; D000069470:Venlafaxine Hydrochloride; D000068736:Duloxetine Hydrochloride; D000078764:Milnacipran; D009638:Norepinephrine; D000069468:Desvenlafaxine Succinate
keywords: chemotherapy; peripheral neuropathy; serotonin-norepinephrine reuptake inhibitor