From the Guidelines
Alpha-lipoic acid (ALA) should be dosed at 600 mg once daily for most therapeutic purposes, including diabetic neuropathy, as this dose has been shown to be equivalent to intravenous infusions and is supported by recent clinical guidelines. This dosing recommendation is based on a meta-analysis of 27 RCTs that demonstrated the benefits of ALA in reducing neuropathic symptoms and deficits, as reported in the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1.
For diabetic neuropathy, the most well-studied use, 600 mg daily is the standard dose, which can be taken all at once or divided into two 300 mg doses. Treatment usually continues for at least 3-6 months to evaluate effectiveness, though many patients take it long-term for ongoing management. Some studies have also explored the use of ALA for other conditions, such as chemotherapy-induced peripheral neuropathy, but the evidence is less clear, with one randomized trial suggesting that ALA may not prevent neuropathy in this context 1.
Key points to consider when dosing ALA include:
- The standard dose for diabetic neuropathy is 600 mg daily
- ALA can be taken orally, with 600 mg once daily being equivalent to intravenous infusions
- Treatment should continue for at least 3-6 months to evaluate effectiveness
- Side effects are generally mild but can include stomach upset, skin rash, or a burning sensation in those with neuropathy
- ALA works by regenerating other antioxidants in the body, improving insulin sensitivity, and protecting nerves from oxidative damage, which explains its benefits for neuropathic conditions and metabolic health.
From the FDA Drug Label
DIRECTIONS: Take one to two softgels daily, or as directed by your physician. For children under 12 years of age, consult your physician. The recommended dosing of ALA is one to two softgels daily, as directed by a physician. For children under 12 years of age, a physician should be consulted for guidance on dosing 2.
- The dose of ALA in the second label is 50 mg per serving, with a serving size of 2 softgels 2.
From the Research
Dosing of Alpha-Lipoic Acid (ALA)
- The dosing of ALA varies across different studies, but a common dosage is 600 mg per day, either orally or intravenously 3, 4, 5, 6, 7.
- A study published in 2021 found that administering 600 mg of ALA orally, two hours before a meal, for eight months, resulted in statistically significant reductions in peripheral neuropathy and depressive disorder in patients with type 2 diabetes mellitus 5.
- Another study published in 2010 found that an oral or intravenous ALA dose of at least 600 mg per day resulted in a 50% reduction in the Total Symptom Score (TSS) for neuropathic pain in patients with diabetes 7.
- The effectiveness of ALA in treating diabetic neuropathy is still a topic of debate, with some studies showing significant improvements in symptoms and others showing no notable results 6.
- However, ALA is generally considered safe and tolerable, with no reported adverse effects in the studies reviewed 6.
Administration and Duration
- The administration of ALA can be oral or intravenous, with oral administration being more common in recent studies 5, 6, 7.
- The duration of ALA treatment also varies, ranging from a few weeks to several months 5, 6, 7.
- A study published in 2021 found that eight months of ALA treatment resulted in significant reductions in peripheral neuropathy and depressive disorder in patients with type 2 diabetes mellitus 5.
Clinical Relevance
- The clinical relevance of ALA treatment for diabetic neuropathy is still a topic of debate, with some studies showing significant improvements in symptoms and others showing no notable results 6.
- However, ALA is generally considered a safe and tolerable treatment option, with no reported adverse effects in the studies reviewed 6.
- Further trials are warranted to corroborate or contradict the hypothesis that ALA is an effective intervention for the treatment of diabetic neuropathy 6.