Topical clonidine for neuropathic pain

Wrzosek, Anna; Woroń, Jarosław; Dobrogowski, Jan; Jakowicka-Wordliczek, Joanna; Wordliczek, Jerzy

doi:10.1002/14651858.cd010967.pub2

Cited by 25 publications

(14 citation statements)

References 84 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, topical clonidine, a presynaptic α-2 adrenergic receptor agonist with antinociceptive activity, was associated with pain relief in DSPN in a small number of studies of low-to-moderate quality [75]. Clonidine gel 0.1% may be administered in single doses of 0.65 g of gel (0.65 mg of clonidine), three times daily so that the total daily dose should not exceed 3.9 mg for both feet.…”

Section: Topical Treatmentmentioning

confidence: 99%

“…No [32] 0.075% four times/d [31] Skin-site reactions [63] Equal efficacy to amitriptyline [62] Capsaicin 8% patch No [68] One application every 3 months [66] Skin-site reactions [66] Conflicting results in DSPN [66]; application can be painful [66]; monitor for transient blood pressure increase for at least one hour following application [66] 5% lidocaine plaster No [70] Maximum 3 lidocaine plasters 5% can be applied to intact skin once daily for a period of 12 h [70] Skin-site reactions [74] Comparable efficacy to pregabalin, amitriptyline, capsaicin, and gabapentin [72,73] Clonidine gel 0.1% No [75] Single doses of 0.65 g of gel, three times daily [76] Skin-site reactions [76] Pain relief in a small number of studies of low-to-moderate quality [75] Pathogenesis-oriented treatment α-Lipoic acid No [77] 600-1800 mg orally or 600 mg/d intravenously for 3 weeks, excluding weekends [77][78][79][80][81] Nausea, vomiting, abdominal discomfort, diarrhea [77] FDA statement: safe and effective treatment option for painful DSPN [82] Legend: FDA: Food and Drug Administration.…”

Section: Capsaicin Creammentioning

confidence: 99%

See 1 more Smart Citation

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

et al. 2020

View full text Add to dashboard Cite

Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.

show abstract

Section: Topical Treatmentmentioning

confidence: 99%

Section: Capsaicin Creammentioning

confidence: 99%

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The analgesic effect is probably a result of the absorption of the drug, and it is associated with a presynaptic decrease of noradrenaline release from endings of the sympathetic nervous system and with an increase in the release of endogenous opioids (enkephalins) [16]. …”

Section: Analgesics Administered Topicallymentioning

confidence: 99%

Transdermal and Topical Drug Administration in the Treatment of Pain

et al. 2018

Self Cite

View full text Add to dashboard Cite

The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients’ age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non–steroidal anti–inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti–inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.

show abstract

“…As such, topical clonidine formulations have been investigated in clinical studies. Two randomized placebo-controlled studies for the treatment of DNP have been conducted in the USA by Wrzosek et al (25) and Campbell et al (87) (Table III). Both studies evaluated the efficacy and safety of topical clonidine gel in DPDN patients.…”

Section: Topical Pharmacological Treatment Of Dnpmentioning

confidence: 99%

Topical treatments for diabetic neuropathic pain (Review)

et al. 2019

View full text Add to dashboard Cite

Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.

show abstract

Topical clonidine for neuropathic pain

Cited by 25 publications

References 84 publications

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

Transdermal and Topical Drug Administration in the Treatment of Pain

Topical treatments for diabetic neuropathic pain (Review)

Contact Info

Product

Resources

About