Arrow pointing up
Doximity share button
foot with neuropathy

January 12, 2022 - The American Academy of Neurology (AAN) issued an update to their diabetic neuropathy guidelines; the last update was in 2011. The recommendations are mostly broad, and when it comes to drug therapies, they list possible treatments but do not give preference to one therapy over another. This is in contrast to the ADA recommendations, which list pregabalin, duloxetine, and gabapentin as first-line agents. The AAN also includes sodium channel blockers (e.g. carbamazepine, lamotrigine), where the ADA does not. Highlights from the guidelines are listed below.

  • Tricyclic antidepressants (amitriptyline, nortriptyline), SNRIs (duloxetine, venlafaxine, desvenlafaxine), gabapentinoids (gabapentin, pregabalin), and/or sodium channel blockers (carbamazepine, oxcarbazepine, lamotrigine, lacosamide) should be offered for treatment
  • In patients preferring topical, nontraditional, or nonpharmacologic interventions, providers may offer topicals (capsaicin, glyceryl trinitrate spray, Citrullus colocynthis), nontraditional (ginkgo biloba), and/or nonpharmacologic interventions (CBT, exercise, Tai Chi, mindfulness)
  • In general, therapies should be tried for 12 weeks before being declared ineffective
  • If a partial response is achieved with one drug, combination therapy with a drug from a different drug class may be considered
  • Opioids, including tramadol and tapentadol, should not be used


Diabetic neuropathy overview

Diabetes management