From the Guidelines
Mechanism of Action and Uses of Alpha-lipoic Acid
Alpha-lipoic acid, also known as thioctic acid, is an antioxidant that exhibits its mechanism of action (MOA) by scavenging free radicals, chelating transition metals, and regenerating other antioxidants, such as vitamins C and E 1. It is primarily used in the treatment of diabetic neuropathy, with medication names including Alpha-Lipoic Acid and Thioctacid.
Efficacy and Administration
The efficacy of alpha-lipoic acid in improving neuropathic symptoms, such as pain and numbness, has been demonstrated in clinical trials, with significant reductions in symptoms observed after treatment 1. Typically, alpha-lipoic acid is administered at a dose of 600 mg orally per day for a duration of 3-5 weeks 1. However, its use in other types of neuropathy, such as HIV-associated peripheral neuropathic pain, is also recommended, albeit with less strong evidence 1.
Considerations and Limitations
While alpha-lipoic acid shows promise in the management of diabetic neuropathy, its effectiveness in preventing chemotherapy-induced peripheral neuropathy is less clear, with some studies indicating no significant ameliorating effect 1. Therefore, its use should be considered on a case-by-case basis, weighing the potential benefits against the limitations and variability in response across different conditions.
- Key points:
- Alpha-lipoic acid is an antioxidant used in treating diabetic neuropathy.
- It scavenges free radicals, chelates transition metals, and regenerates other antioxidants.
- Typical administration is 600 mg orally per day for 3-5 weeks.
- Efficacy is established for diabetic neuropathy, with less strong evidence for other types of neuropathy.
- Its role in preventing chemotherapy-induced neuropathy is unclear and may not be effective.
From the Research
Mechanism of Action
- Alpha-lipoic acid (thioctic acid) has been shown to have antioxidant properties, which help to reduce oxidative stress and improve nerve function in diabetic patients 2, 3, 4.
- The mechanisms of action of alpha-lipoic acid in experimental diabetic neuropathy include reduction of oxidative stress, improvement in nerve blood flow, and improvement in nerve conduction velocity 3.
- Alpha-lipoic acid also increases reduced glutathione, an important endogenous antioxidant, which helps to delay or reverse peripheral diabetic neuropathy 4.
Uses
- Alpha-lipoic acid is used in the treatment of diabetic neuropathy, a serious complication of diabetes that affects the nerves 2, 5, 3, 6, 4.
- It is also used to improve symptoms of diabetic polyneuropathy, such as pain, burning, paraesthesiae, and numbness 2, 5.
- Alpha-lipoic acid may be chosen in patients with early neuropathic deficits and symptoms, in whom clinical improvement is more likely, and in patients with comorbidities that render other analgesics less appropriate 3.
Efficacy
- Clinical trials have shown that alpha-lipoic acid is efficacious and safe for the treatment of diabetic neuropathy, accomplishing clinically meaningful improvements 2, 5, 3, 6.
- A dose of 600 mg/day of alpha-lipoic acid has been shown to reduce symptoms of diabetic polyneuropathy and improve neuropathic deficits 2, 5.
- Alpha-lipoic acid has also been shown to improve quality of life in patients with painful diabetic neuropathy, reducing neuropathic symptoms and improving work disability, social life disability, and family life disability scores 6.
- The efficacy of alpha-lipoic acid has been demonstrated in both short-term and long-term studies, with significant reductions in neuropathic symptoms and improvements in quality of life observed after 3 weeks to 2 years of treatment 2, 5, 6.