What Medications Can Treat Diabetic Neuropathy?
Key takeaways:
Several medications treat diabetic neuropathy, a type of nerve damage caused by diabetes. Understanding their side effects and how they work can help you choose the right one for you.
These medications don’t reverse nerve damage, but they can help manage symptoms, like pain and burning.
Other ways to treat diabetic neuropathy include keeping your blood sugars in a healthy range and maintaining a healthy weight and blood pressure.
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Diabetes is a complex condition — it can cause a lot of changes in your body. One of those potential changes is diabetic neuropathy, which is a type of nerve damage. High blood sugar levels over time can interrupt blood flow to your nerves, harming them in the long run.
If you or a loved one with diabetes has pain, burning, or numbness in your hands or feet, you may be feeling symptoms of diabetic peripheral neuropathy, which is a type of diabetic neuropathy. And if so, you’re not alone. Research shows that more than half of people with diabetes have nerve damage.
Diabetic neuropathy can make day-to-day life tough. It usually affects your feet and lower limbs first, which can limit how much you’re able to move around. It can ultimately end up affecting your quality of life.
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So, how do we treat it? First, keeping your blood sugars controlled can slow down the development of nerve damage. On top of that, certain medications can help manage symptoms, such as pain. Keep reading to find out more about these pain-reducing medications.
What medications are available to treat diabetic neuropathy?
You and your healthcare provider have many options to consider. Below, we've listed out common first-choice medications as well as alternative options to consider.
First-choice medications
Three medications are possible go-to choices for diabetic neuropathy.
Pregabalin
Pregabalin (Lyrica) is FDA-approved to treat diabetic neuropathy. It’s an oral medication that’s usually taken 2 to 3 times per day. Among all the medications used for diabetic neuropathy, pregabalin has the most research behind it.
However, pregabalin’s cost — both brand-name and generic — runs higher than the other medications in this list. It’s also a controlled substance, so savings opportunities vary by pharmacy.
Gabapentin
Gabapentin (Neurontin) is a cousin to pregabalin, but it’s a bit cheaper. It’s not FDA-approved to treat diabetic neuropathy, but it’s typically used off-label for this purpose. It’s often recommended as another first-choice option.
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Duloxetine
Duloxetine (Cymbalta) is another medication that’s FDA-approved to treat diabetic neuropathy. It’s an oral medication that’s taken once per day. You might also recognize that it’s used to treat depression and a few other health conditions.
Duloxetine tends to be a bit cheaper than medications like pregabalin. The average retail price for a 1-month supply is around $121, and a GoodRx coupon can bring it down to as low as $3.
Other medication options
If pregabalin, gabapentin, or duloxetine aren’t possible options, other choices are also available. These are listed below.
However, aside from what’s listed next, know that a few other medications are also used off-label for diabetic neuropathy. But the evidence supporting their use is more limited, so they're not discussed here.
Venlafaxine
Venlafaxine (Effexor) is in the same medication class as duloxetine, and it’s also FDA-approved to treat depression. But it’s not approved for diabetic neuropathy, and it’s not as well studied as duloxetine for this purpose. But some people still use it for diabetic neuropathy.
Amitriptyline
Amitriptyline is an older and cheaper medication that can treat diabetic neuropathy. Like gabapentin and venlafaxine, it’s not FDA-approved for this purpose. But it’s still a possible option to consider.
However, amitriptyline isn’t generally recommended for older adults due to its side effects.
Opioid medications
Opioid medications, like tapentadol ER (Nucynta ER), are sometimes used to treat diabetic neuropathy, but they’re not recommended due to safety concerns. However, tapentadol ER is FDA-approved to manage diabetic neuropathy pain that’s severe enough to need long-term opioid treatment.
Topical medications
Topical medications — like lidocaine (Lidoderm) or capsaicin — are sometimes recommended for mild symptoms and small areas of pain. These options are applied to the skin and can be combined with oral pills. The capsaicin 8% patch, also known as Qutenza, is FDA-approved to treat diabetic nerve pain in your feet.
Supplements and medical food products
The following two nontraditional options are sometimes used with the medications listed above. Your healthcare provider can tell you if either of them may be helpful.
Metanx
L-methylfolate, pyridoxal-5'-phosphate, and methylcobalamin (Metanx) is a prescription medical food product. It’s made of an active form of folate and other essential B vitamins. It’s used to provide nutritional support for people with nerve pain.
Alpha-lipoic acid
Alpha-lipoic acid is a nutritional supplement. It’s an antioxidant that can help improve nerve function. But there’s not much research on its long-term clinical benefits.
How effective are diabetic neuropathy medications?
There’s no treatment that can reverse nerve damage caused by diabetes. But each of the medications mentioned above have been shown to improve diabetes-related nerve pain when compared to placebo (a pill with no medication in it). Pregabalin, the most studied of the bunch, has been shown to improve pain by at least 30% to 50% in many research studies.
However, there isn’t much high-quality research comparing these medications to each other. The effectiveness of these medications varies from person to person.
Oftentimes, it’s a trial-and-error process to find a medication that works for you. And it’s recommended to try a medication for approximately 12 weeks before deciding that it’s not working. If the first medication doesn’t help your symptoms, your healthcare provider may suggest adding a second one or switching to a different one.
What are the most common side effects of diabetic neuropathy medications?
We’ve summarized some common side effects for each medication and the likelihood they may occur. Keep in mind that many of these side effects may be more severe in older adults. In this case, it’s best to start with lower doses and adjust your dose slowly.
This isn’t a complete list of side effects. Rare but serious side effects are also possible. For more information, it’s recommended to speak to a pharmacist.
How long do you have to take diabetic neuropathy medications?
You may have to take medications for as long as your nerve pain continues. For some people, that can be lifelong. For others, pain can improve over time. Your medication dose can also change over time based on what’s working for your pain.
Make sure to give your healthcare provider regular updates and feedback about what’s working and what’s not.
Is one medication best for diabetic neuropathy?
The answer isn’t clear. Much of the current research doesn’t tell us about long-term benefits, like if these medications improve quality of life.
Still, pregabalin and duloxetine are often go-to options for symptom management since they’re FDA-approved to treat pain from diabetic neuropathy. Gabapentin is also a go-to choice. But the answer can be more complicated if you bring other factors into the picture.
When choosing a medication, you and your healthcare provider will also consider other health conditions you may have and how many times you’d have to take the medication each day. It’s also useful to keep track of possible side effects and the cost of each medication.
Can you treat diabetic neuropathy without medication?
There are lifestyle changes that can help prevent or relieve symptoms of diabetic neuropathy. These changes improve blood circulation and as a result, improve your nerve function. Examples include:
Exercising regularly
Improving blood pressure and cholesterol levels
Limiting alcohol use
Keeping your blood sugars in a healthy range is also key. Why is this important? High blood sugar levels can cause severe nerve damage over time — even possibly a loss of feeling in your feet. Without sensation in your feet, cuts and sores may be hard to notice and they could turn into an infection.
You should check your feet every day for dry or cracked skin, cuts or wounds, and anything else out of the ordinary. These issues can be a sign of worsening nerve damage that you should treat right away.
The bottom line
Diabetic neuropathy is a type of nerve damage that’s caused by diabetes. Many medications — including pregabalin, duloxetine, and gabapentin — are often used to help manage this pain. But these medications differ in cost, side effects, and other health conditions they can treat.
Treating symptoms of diabetic neuropathy is often a trial-and-error process. Talk to your healthcare provider about some of the things we’ve mentioned above to see what’s right for you.
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References
American Diabetes Association Professional Practice Committee. (2021). Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes–2022. Diabetes Care.
Centers for Disease Control and Prevention. (2021). Diabetes and nerve damage.
Fonseca, V. A., et al. (2013). Metanx in type 2 diabetes with peripheral neuropathy: A randomized trial. The American Journal of Medicine.
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). What is diabetic neuropathy?
Pop-Busui, R., et al. (2016). Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care.
Price, R., et al. (2022). Oral and topical treatment of painful diabetic polyneuropathy: Practice guideline update summary: Report of the AAN Guideline Subcommittee. Neurology.
Snyder, M. J., et al. (2016). Treating painful diabetic peripheral neuropathy: An update. American Family Physician.
U.S. Food and Drug Administration. (2022). Medical foods guidance documents & regulatory information.
Waldfogel, J. M., et al. (2017). Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology.
Ziegler, D., et al. (2006). Oral treatment with a-lipoic acid improves symptomatic diabetic polyneuropathy: The SYDNEY 2 trial. Diabetes Care.
