Pharmacologic Treatment of Autonomic Neuropathy
| Clinical status | Drug | Dosage | Side effects |
|---|---|---|---|
| Orthostatic hypotension | |||
| 9α flouro hydrocortisone, mineralocorticoid | 0.5-2 mg/day | Congestive heart failure, hypertension | |
| Clonidine, α2 adrenergic agonist | 0,1-0,5 mg, at bedtime | Orthostatic Hypotension, sedation, dry mouth, constipation, dizziness, bradycardia. | |
| Octreotide, somatostatin analogue | 0.1-0.5 mg/kg/day | Injection site pain, diarrhea | |
| Orthostatic tachycardia and bradycardia syndrome | |||
| Clonidine, α2 adrenergic agonist | 0.1-0.5 mg, at bedtime | Orthostatic Hypotension, sedation, dry mouth, constipation, dizziness, bradycardia. | |
| Octreotide, somatostatin analogue | 0.1-0.5 μg/kg/day | Injection site pain, diarrhea | |
| Gastroparesis diabeticorum | |||
| Domperidone, D2-receptor antagonist | 10-20 mg, 30-60 min before meal and bedtime | Galactorrhea | |
| Erythromycin, motilin receptor agonist | 250 mg, 30 minutes before meals | Abdominal cramps, nausea, diarrhea, rash | |
| Levosulphide, D2-receptor antagonist | 25 mg, 3 times/day | Galactorrhea | |
| Diabetic diarrhea | |||
| Metronidazole, broad spectrum antibiotics | 250 mg, 3 times/day, minimum 3 weeks | Anorexia, rash, GI upset, urine discoloration, dizziness, disulfiram like reaction. | |
| Clonidine, α2 adrenergic agonist | 0.1 mg, 2-3 times/day | Orthostatic Hypotension, sedation, dry mouth, constipation, dizziness, bradycardia. | |
| Cholestyramine, bile acid sequestrant | 4 g, 1-6 times/day | Constipation | |
| Loperamide, opiate-receptor agonist | 2 mg, four times/day | Toxic megacolon | |
| Octreotide, somatostatin analogue | 50 μg, 3 times/day | Aggravate nutrient malabsorption (at higher doses) | |
| Cystopathy | |||
| Bethanechol, acetylcholine receptor agonist | 10 mg, 4 times/day | Blurred vision, abdominal cramps, diarrhea, salivation, and hypotension. | |
| Doxazosin, α1 adrenergic antagonist | 1-2 mg, 2-3 times/day | Hypotension, headache, palpitation | |
| Exercise Intolerance | |||
| Graded supervised exercise | 20 minutes, 3 times/week | Foot injury, angina. | |
| Hyperhidrosis | |||
| Clonidine, α2 adrenergic agonist | 0.1-0.5 mg, at bedtime and divided doses above 0.2 mg | Orthostatic Hypotension, sedation, dry mouth, constipation, dizziness, bradycardia. | |
| Amitryptiline, Norepinephrine & serotonin reuptake inhibitor | 150 mg/ day | Tachycardia, palpitation | |
| Propantheline, Anti-muscarinic. | 15 mg/ day PO | Dry mouth, blurred vision | |
| Trihexyphenidyl, | 2-5 mg PO | Dry mouth, blurred vision, constipation, tachycardia, photosensitivity, arrhythmias. | |
| Botox, | |||
| Scopolamine, anti-cholinergic | 1.5 mg patch/ 3 days; 0.4 to 0.8mg PO | Dry mouth, blurred vision, constipation, drowsiness, and tachycardia. | |
| Glycopyrrolate, anti-cholinergic | 1-2 mg, 2-3 times daily. | Constipation, tachycardia, dry mouth. | |
| Erectile dysfunction | |||
| Sildenafil (Viagra), GMP type-5 phosphodiesterase inhibitor | 50 mg before sexual activity, only once per day | Hypotension and fatal cardiac event (with nitrate-containing drugs), headache, flushing, nasal congestion, dyspepsia, musculoskeletal pain, blurred vision | |
| Tadalafil (Cialis), GMP type-5 phosphodiesterase inhibitor | 10 mg PO before sexual activity only once per day. | Headache, flushing, dyspepsia, rhinitis, myalgia, back pain. | |
| Verdenafil (Levitra), GMP type-5 phosphodiesterase inhibitor | 10 mg PO, 60 minutes before sexual activity. | Hypotension, headache, dyspepsia, priapism. | |
From: Diabetic Neuropathies
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