Ann Pharmacol Pharm | Volume 3, Issue 4 | Case Report | Open Access
Keppel Hesselink JM*
Institute for Neuropathic Pain, Spoorlaan 2a, 3735 MV Bosch en Duin, Netherlands
*Correspondance to: Keppel Hesselink JM
Fulltext PDFTreatment of Painful Diabetic Neuropathy (PDN) is still quite suboptimal. The use of many of the analgesics and co-analgesics recommended in most guidelines is complicated by issues as adverse events, low compliance and drug-drug interactions. Thus, the numbers needed to treat for most drugs in this field is relative high, while numbers needed to harm are low. This holds true for the western industrialized population, but definitely also for populations in Sub-Saharan Africa (SSA), as most of the analgesics of choice are not listed on the essential lists of these countries. Detailed data on the prevalence and incidence of PDN are also missing. It is estimated that PDN will increase considerably in the near future. Moreover, well controlled clinical trials evaluating the efficacy and safety of most currently used analgesics in these countries are extremely scarce if not absent. As the metabolism in the black population is known to be different from the white population, side-effects can vary and toxic metabolites might be induced in both populations in different frequencies, as has been demonstrated for opioids. Thus, there is a great need for new approaches in the treatment of PDN, and repositioning old drugs in new topical formulations might be of use. We will present the rationale to evaluate topical Phenytoin cream as a new treatment option in PDN, suitable for the SSA and present first steps related to a pilot trial in the Gambia.
Repurposing; Development countries; Neuropathic; Gambia
Keppel Hesselink JM. Treatment of Painful Diabetic Neuropathy in Sub- Saharan Countries: Bottlenecks and Opportunity for the Repositioning of Phenytoin as a Topical Treatment. Ann Pharmacol Pharm. 2018; 3(4): 1154.