The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on duloxetine (Cymbalta®) for diabetic peripheral neuropathic pain in adults.

The Committee concluded that duloxetine  is suitable for primary care prescribing in this situation. It noted that the evidence for benefit was relatively strong, and that a draft NICE guideline recommends it for first-line use.

Duloxetine had been assessed in this indication in three placebo-controlled trials, reducing 24-hour pain scores to a significantly greater degree than placebo in all three. There were also benefits in a number of secondary outcomes. Adverse effects including somnolence, dizziness, fatigue, and gastro-intestinal disturbance were more frequent in patients taking duloxetine. A dose of 120mg did not seem to be more effective than 60mg, and it has not been compared to other drugs used in the condition.

The document is available from the MTRAC website, and at time of posting is linked from their Latest News page