Annexures 5 - SA HealthInfo
Annexures 5 - SA HealthInfo
Annexures 5 - SA HealthInfo
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Annexure 14<br />
Management algorithm for peripheral neuropathy<br />
EVALUATION<br />
• Burning sensation, pins and needles?<br />
• Numbness of both feet, worse at night or<br />
when walking?<br />
• Leg weakness when walking?<br />
• Leg cramps or pain?<br />
No<br />
OBSERVATION<br />
Yes<br />
• Rule out other causes, including diabetes,<br />
alcoholism, vitamin deficiencies, HIV,<br />
hypothyroidism, uremia, other drugs, etc.<br />
• Treat other likely causes<br />
TREATMENT<br />
Step 1<br />
Step 2<br />
Step 3<br />
Step 4<br />
Step 5<br />
Increase pyridoxine to 200 mg, consider multivitamins<br />
Replace drugs most likely responsible if equally efficacious anti-TB drugs available.<br />
Begin exercise regimen, focusing on affected regions<br />
For severe pain<br />
• Initiate low-dose tricyclic anti-depressant (eg. nortriptyline, amytriptyline, desiprimine)<br />
• Start at 25 mg at bedtime; increase 10-25 mg every three to seven days until 150 mg/day<br />
(although the majority respond to 75 mg/d)<br />
If continued pain<br />
• Consider neurology consultation<br />
• If no improvement, decrease dose of responsible medication, then resume normal dose<br />
once pain controlled<br />
If no improvement<br />
• Start gabapentin at 300 mg QHS; increase by 600 mg every three to seven days until<br />
response: maximum dose 1200 TID<br />
• If no improvement, consider carbamezepine (start at 200 mg BID; increase to 600 mg BID)<br />
• Consider the use of phenytoin
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