From the Guidelines
Alternatives to alpha lipoic acid for managing neuropathy include prescription medications such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers, as recommended by the most recent guidelines 1. Several alternatives to alpha lipoic acid (ALA) for managing neuropathy include:
- Prescription medications, such as:
- Anticonvulsants: pregabalin (Lyrica, 150-600 mg/day), gabapentin (Neurontin, 900-3600 mg/day)
- Antidepressants: duloxetine (Cymbalta, 60-120 mg/day), amitriptyline (10-150 mg/day)
- Topical treatments: capsaicin cream (0.025-0.075%), lidocaine patches (5%)
- Alternative supplements: B vitamins (particularly B1, B6, and B12), acetyl-L-carnitine (500-1000 mg twice daily), omega-3 fatty acids (1-3 g daily)
- Non-pharmacological approaches: physical therapy, transcutaneous electrical nerve stimulation (TENS), acupuncture, maintaining tight blood glucose control for diabetic neuropathy
- Lifestyle modifications: regular exercise, avoiding alcohol, maintaining a healthy weight These alternatives are supported by recent guidelines, including those from the American Academy of Neurology and the American Diabetes Association 1. The most recent and highest quality study 1 recommends gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers as initial pharmacologic treatments for neuropathic pain in diabetes. Treatment should be individualized based on the underlying cause of neuropathy, symptom severity, and potential side effects of each intervention, as suggested by the guidelines 1.
From the Research
Alternatives to Alpha Lipoic Acid for Neuropathy
Alternatives to alpha lipoic acid (ALA) for managing neuropathy include:
- Acetyl-L-carnitine (ALC) 2
- Benfotiamine 3
- Methylcobalamin 3
- Topical capsaicin 3
- Vitamin E 3
- Glutathione 3
- Folate 3
- Pyridoxine 3
- Biotin 3
- Myo-inositol 3
- Omega-3 and -6 fatty acids 3
- L-arginine 3
- L-glutamine 3
- Taurine 3
- N-acetylcysteine 3
- Zinc 3
- Magnesium 3
- Chromium 3
- St. John's wort 3
Mechanisms of Action
These alternatives have various mechanisms of action, including:
- Neuroprotective effects (ALC) 2
- Regeneration of nerves (ALC) 2
- Improvement in nerve conduction velocity (ALA, ALC) 4, 2
- Reduction of oxidative stress (ALA) 4, 5, 6
- Improvement in symptoms of diabetic peripheral neuropathy (ALA) 4, 5, 6
Efficacy and Safety
The efficacy and safety of these alternatives have been studied in various clinical trials, with results showing: