Diabetic Neuropathy Drug Summary

Last updated: 29 October 2025
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Antidiarrheal

Content on this page:

Antidiarrheal

Anticoagulant


Drug Dosage Remarks
Sulodexide Initial dose: 600 lipasemic units (LSU)
IM/IV 24 hourly x 15-20 days followed by PO form x 30-40 days 
Repeat cycle twice yearly 

Maintenance dose: 250-1,000 LSU PO
12 hourly 
 Adverse Reactions
  • CNS effect (vertigo); GI effects (upper abdominal pain, diarrhea, nausea/vomiting); Injection site reactions (burning sensation, pain, hematoma); Other effect (rash) 
Special Instructions
  • Should be taken without food
  • Contraindicated in patients with hypersensitivity to Heparin and heparin-like products or with diathesis and hemorrhagic diseases
  • Monitor hemocoagulative parameters periodically

Anticonvulsants


Drug Dosage Remarks
Other Anticonvulsants
Gabapentin Initial dose: 
Day 1: 300 mg PO 24 hourly 
Day 2: 300 mg PO 12 hourly 
Day 3: 300 mg PO 8 hourly or
Initiate at 900 mg/day PO in 3 equally divided doses
Based on patient response and tolerability, may increase dose in increments of 300 mg/day every 2-3 days up to a max dose of 3,600 mg/day
Max dose: 3.6 g/day 		 Adverse Reactions
  • CNS effects (somnolence, dizziness, ataxia, nystagmus, headache, tremor, diplopia, amblyopia); Other effects (fatigue, nausea &/or vomiting) 
Special Instructions
  • Use with caution in patients with history of psychotic illness, renal impairment
  • Discontinuation and/or addition or substitution of alternative therapy should be gradual over at least 1 week
  • May affect patients ability to drive or operate machinery
Pregabalin Initial dose: 150 mg/day PO divided 8-12 hourly 
May be increased to 300 mg/day after a 3- to 7-day interval 
May increase further to max dose after another 7-day interval 
Max dose: 600 mg/day		 Adverse Reactions
  • CNS effects (somnolence, dizziness, confusion, euphoric mood, ataxia, attention disturbance, abnormal coordination, memory impairment, tremor, dysarthria, paresthesia, blurred vision, diplopia, vertigo, increased appetite, decreased libido, erectile dysfunction, irritability); GI effects (constipation, vomiting, flatulence, dry mouth); Other effect (fatigue)
Special Instructions
  • Use with caution in patients with galactose intolerance, lactase deficiency or glucose-galactose malabsorption, renal impairment, DM
  • May affect patients ability to drive or operate machinery 

Antidepressants


Drug Dosage Remarks
Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
Duloxetine 60 mg PO 24 hourly
Max dose: 120 mg/day

Adverse Reactions

  • CNS effects (somnolence, dizziness, insomnia, nervousness, anorexia, anxiety); GI effects (constipation, diarrhea, nausea, xerostomia); Other effects (abnormal dreams, yawning, tremor, blurred vision, increased sweating, weight loss, sexual dysfunction) 

Special Instructions

  • Use with caution in renal and hepatic impairment
  • Do not stop medication abruptly; taper dose over several weeks 
Venlafaxine Initial dose: 37.5 mg PO 24 hourly x 1 week, then 75 mg PO 24 hourly x 1 week, then 150 mg PO 24 hourly
Max dose: 225 mg/day
Tricyclic Antidepressants (TCAs)
Amitriptyline Initial dose: 10-25 mg PO at bedtime
Increase dose by 10-25 mg/day to max dose on a weekly interval depending on response and tolerability 
Max dose: 150 mg/day

Adverse Reactions

  • Side effects are mostly due to antimuscarinic actions and may be decreased if started at low dose and increased gradually
  • GI effects (dry mouth, constipation which may lead to paralytic ileus, gastric irritation, nausea/vomiting); Ophthalmic effects (blurred vision, increased intraocular pressure); CNS (drowsiness, nervousness, insomnia, headache, confusion/delirium can occur especially in older patients, peripheral neuropathy, ataxia, tremor); CV effects (hypotension, tachycardia); Other effects (urinary retention, hyperthermia, sweating, weight gain)

Special Instructions

  • Start with a low dose to minimize side effects and titrate upward to the desired response
  • Total daily dose should be given at bedtime
  • Not recommended for elderly patients and those with CV disease
  • Use with caution in patients with urinary retention, prostatic hyperplasia, chronic constipation, untreated angle-closure glaucoma, CV disease, history of epilepsy, DM, impaired hepatic and renal function
  • Do not stop medication abruptly; taper dose over several weeks
Nortriptyline Initial dose: 10-25 mg PO at bedtime 
Increase dose by 10-25 mg/day to max dose on a weekly interval based on response and tolerability 
Usual dose: 25-100 mg PO at bedtime 
Max dose: 150 mg/day

Antidiarrheal


Drug Dosage Remarks
Colestyramine
(Cholestyramine) 		 Diarrhea due to diabetic vagal neuropathy: 
Initial dose:
4 g (1 sachet) PO 12 hourly 
May increase to 8 g PO 12 hourly after 2-4 weeks
Max dose: 24 g/day
 Adverse Reactions
  • GI effects (constipation, abdominal discomfort, flatulence, nausea/vomiting, diarrhea, heartburn, anorexia, steatorrhea, pancreatitis); Dermatologic effects (rash, irritation, urticaria); CNS effects (headache, anxiety, vertigo, dizziness, fatigue, syncope, drowsiness); Hematologic effects (anemia, prolonged prothrombin time, ecchymosis); Musculoskeletal effects (muscle and joint pains, backache); Renal effects (hematuria, dysuria); Respiratory effects (wheezing, shortness of breath, asthma) 
Special Instructions
  • Contraindicated in patients with complete biliary obstruction
  • Use with caution in patients with hypothyroidism, DM, nephrotic syndrome, dysproteinemia, obstructive liver disease
  • Monitor serum triglyceride periodically 

Drugs for Neuropathic Pain


Drug Dosage Remarks
Mirogabalin Initial dose:
5 mg PO 12 hourly, then increase dose by 5 mg/dosing with at least 1 week interval up to 15 mg 12 hourly
May increase or decrease dose between 10 mg and 15 mg 12 hourly 
 Adverse Reactions
  • CNS effects (somnolence, dizziness); Other effects (constipation, edema, gait disturbance, increased weight and hepatic enzyme)
Special Instructions
  • Use with caution in patients with hepatic function disorder
  • Potential occurrence of obesity, measure weight regularly; ophthalmic disorders; withdrawal symptoms (eg insomnia, nausea, diarrhea, decreased appetite) with abrupt treatment discontinuation
  • Women of childbearing potential should use effective contraception
  • Not to operate potentially dangerous machinery
Thioctic acid 
(α-lipoic acid)1 		 600 mg PO 24 hourly or
600 mg slow IV infusion 24 hourly x 2-4 weeks or several times/week
 Adverse Reactions
  • GI effects (nausea/vomiting, stomach and intestinal pain, diarrhea); CNS effects (vertigo, headache); Dermatologic effects (rash, urticaria, itching); Other effects (sweating, visual disturbances) 
Special Instructions
  • Should be taken 30 minutes before meals
    • Swallow whole, do not chew or crush
  • Monitor glucose levels in urine and blood regularly
    • May potentiate hypoglycemic effect of insulin or oral antidiabetics
  • Advise patient to avoid alcohol intake
1Various combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

GIT Regulators, Antiflatulents & Anti-inflammatories


Drug Dosage Remarks
Domperidone Diabetic gastroparesis:
10 mg PO 6-8 hourly 
 Adverse Reactions
  • Hormone effects (galactorrhea, reduced libido, breast pain and tenderness); GI effects (dry mouth, diarrhea); CNS effects (headache, anxiety, somnolence, dystonic reactions); Dermatologic effects (rash, pruritus); Other effect (asthenia) 
Special Instructions
  • Should be taken 15-50 minutes before meals
  • Contraindicated in patients with GI hemorrhage, obstruction or perforation
Metoclopramide Diabetic gastroparesis: 
5-10 mg PO 6-12 hourly 
or
5-10 mg IM/slow IV over 1-2 minutes 6-12 hourly in severe cases
Max dose: 40 mg/day 
 Adverse Reactions
  • CNS effects (drowsiness, fatigue, lassitude, restlessness, extrapyramidal reactions); GI effects (diarrhea, constipation, dry mouth); Dermatologic effect (urticaria); Other effects (glossal or periorbital edema, methemoglobinemia) 
Special Instructions
  • Should be taken 30 minutes before meals or at bedtime 
  • Avoid use in patients with GI hemorrhage, obstruction, or perforation, epilepsy and on drugs which cause extrapyramidal reactions, pheochromocytoma 
  • Use with caution in patients with renal failure
  • May impair ability to drive or operate machinery

Opioids


Drug Dosage Remarks
Tapentadol Extended-release:
50 mg PO 12 hourly 
May increase by 100 mg/day every 3 days based on patient response 
Therapeutic range: 100-250 mg PO 12 hourly 
Max dose: 500 mg/day 
 Adverse Reactions
  • CNS effects (dizziness, somnolence, fatigue, CNS depression, seizures, syncope, drowsiness, headache); GI effects (nausea/vomiting, constipation, dry mouth); Dermatologic effects (pruritus, hyperhidrosis); Other effect (orthostatic hypotension) 
Special Instructions
  • Contraindicated in patients with respiratory depression, acute or severe asthma, GI obstruction or suspected paralytic ileus
  • Not to be used with or within 14 days of monoamine oxidase (MAO) inhibitors
  • Use with caution in patients with head injury, brain tumors, biliary tract disease, history of seizures, moderate-severe hepatic impairment, severe renal impairment
  • Abrupt drug withdrawal should be avoided
Tramadol Regular-release:
50-100 mg PO 4-6 hourly 
Extended-release:
50-100 mg PO 12 hourly 
May be titrated to 150-200 mg 12 hourly for pain relief 
Max dose: 400 mg/day
 Adverse Reactions
  • CNS effects (dizziness, drowsiness, headache, vertigo); GI effects (dry mouth, vomiting, constipation, dyspepsia); CV effect (vasodilation); Other effect (sweating) 
Special Instructions
  • An increase risk in seizures may occur in patients taking other medications which decrease the seizure threshold
  • Use with caution in patients with history of opioid dependence, seizures or at risk for seizures, increased intracranial pressure, renal and hepatic impairment 
  • May cause dependence on long-term use
  • Abrupt drug withdrawal after prolonged use should be avoided

Topical Agents


Drug Available Strength Dosage Remarks
Anesthetic
Lidocaine
(Lignocaine)		 5% patch 

4 patches/day for a max of 12 hours

Adverse Reactions

  • Mild local reactions (itching, erythema, edema)
  • Rarely methemoglobinemia 
Special Instructions
  • Do not use for >12 hours in a 24-hour period
Other Agent 
Capsaicin
 0.0125% gel 
0.025% gel, lotion 
0.075% cream, lotion 

Apply 6-8 hourly 

Adverse Reactions

  • Local effects (application site, erythema, burning and site pain); Other effect (limb pain) 
Special Instructions
  • Before applying the Capsaicin patch, treat the affected area and 1-2 cm of the surrounding area with local anesthetic 

 
8% dermal patch

Apply up to 4 patches/application for 30 minutes
Repeat no more frequently than every 3 months 

Vasoconstrictor


Drug Dosage Remarks
Midodrine Initial dose: 2.5 mg PO 8-12 hourly 
May increase dose weekly up to 10 mg PO 8 hourly
Max dose: 30 mg/day
 Adverse Reactions
  • Dermatologic effects (pruritus, pilo-erection); Other effects (chills, paresthesia, supine hypertension, urinary retention, headache)
Special Instructions
  • Should be taken with meals
    • Last dose must be taken at least 4 hours before bedtime to prevent supine hypertension
  • Avoid in patients with hypertension, bradycardia, urinary retention, ischemic heart disease, congestive heart failure, cardiac conduction disturbances, narrow angle glaucoma, obliterative blood vessel disease, cerebrovascular occlusions and vessel spasms, aortic aneurysm, proliferative diabetic retinopathy, thyrotoxicosis, pheochromocytoma, severe renal impairment, serious prostate disorder 
  • Use with caution in patients with initial supine systolic BP >180 mmHg, renal and hepatic impairment, urinary retention problems, DM, history of visual problems
  • Monitor supine and sitting BP during maintenance therapy

Vitamin B-Complex/With C


Drug Dosage Remarks
Benfotiamine1 Initial dose: 150 mg PO 8-12 hourly for at least 3 weeks 
Maintenance dose: According to therapeutic response 
 Adverse Reactions
  • Rarely, hypersensitivity reactions (skin eruptions, urticaria, anaphylactic reactions) 
 
Mecobalamin1
 0.5 mg PO 8 hourly or 0.5 mg IM/IV 3x/week   Adverse Reactions
  • Oral: Loss of appetite, nausea/vomiting, diarrhea, GI upset, headache
  • Injection: Hypersensitivity reactions, pain, induration at IM sites, headache, sweating 
1Various combination products are available. Please see the latest MIMS for specific formulations and prescribing information.

Drug Available Strength Dosage Remarks
Combination Products
Vitamin B1, B6, B12

 Vitamin B1 250 mg, B6 250 mg, B12 1,000 mcg

Initial dose:
2-4 tab/day PO 
Maintenance dose:
1-2 tab PO 24 hourly 

Adverse Reactions

  • GI effects (nausea/vomiting, abdominal pain, diarrhea); Hypersensitivity reactions (sweating, tachycardia, pruritus, urticaria)
Special Instructions
  • Avoid in patients with galactose or fructose intolerance, glucose-galactose malabsorption, Lapp lactase deficiency, or sucrase-isomaltase insufficiency
  • Use with caution in patients on Levodopa therapy 

 
 
Vitamin B1 300 mg, B6 100 mg, B12 100 mcg

Initial dose: 2-4 tab/day PO 
Maintenance dose:
1-2 tab PO 24 hourly  
Vitamin B1 500 mg, B6 250 mg, B12 1,000 mcg   Initial dose: 2-4 tab/day PO x 7-10 days 
Maintenance dose:
1-2 tab PO 24 hourly 
Vitamin B1 100 mg, B6 200 mg, B12 200 mcg   Initial dose: 1-2 tab PO 8-24 hourly
Vitamin B1 100 mg, B6 100 mg, B12 5,000 mcg   2-4 tab/day PO in divided doses or
1 tab PO 24 hourly 
Vitamin B1 100 mg, B6 100 mg, B12 1,000 mcg   1 amp IM 24 hourly  
Vitamin B1 100 mg, B6 100 mg, B12 5,000 mcg

1 amp IM 24 hourly
Follow-up therapy/milder cases:
2-3 amp/week  

Disclaimer

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.