Autonomic neuropathy


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Treatments and drugs

By Mayo Clinic staff

Treatment of autonomic neuropathy includes:

  • Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to control your blood sugar to keep it as close to normal as possible. Treating the underlying disease can help stop autonomic neuropathy from progressing.
  • Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms
Your doctor may recommend:

  • Modifying your diet. This could include increasing the amount of fiber you eat and fluids you drink. Supplements containing fiber, such as Metamucil or Citrucel, also may help. Be sure to increase the fiber in your diet slowly to avoid gas and bloating.
  • Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
  • Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. In addition, increasing the amount of fiber in your diet may help relieve constipation.
  • Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil) or nortriptyline (Pamelor), can help treat diarrhea and abdominal pain. Dry mouth and urine retention are possible side effects of these medications.

Urinary symptoms
Your doctor may suggest:

  • Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
  • Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
  • Urinary assistance (catheterization). During this procedure, a tube is threaded through your urethra to empty your bladder.
  • Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction
For men with erectile dysfunction, your doctor may recommend:

  • Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and altered color vision. Men with a history of heart disease, stroke or high blood pressure need to use these medications with caution and medical supervision. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
  • An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

  • Vaginal lubricants. If vaginal dryness is a problem, vaginal lubricants may make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:

  • Medications that help raise your blood pressure. If you get dizzy or feel faint when you stand up, your doctor may suggest a drug called fludrocortisone acetate. This medication helps your body retain salt, which helps regulate your blood pressure. Other drugs that can help raise your blood pressure include midodrine (ProAmatine) and pyridostigmine (Mestinon). High blood pressure when lying down is a possible side effect of midodrine.
  • Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if your heart rate doesn't respond normally to changes in activity level.
  • A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure.

Sweating
If you experience excessive sweating, your doctor may prescribe:

  • A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include dry mouth, urinary retention, blurred vision, changes in heart rate, loss of taste and drowsiness.

There is no medication to increase sweating if you have lost the ability to sweat.

Lifestyle and home remedies Tests and diagnosis
References
  1. Gardner DG, et al. Greenspan's Basic & Clinical Endocrinology. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=8407307. Accessed May 21, 2012.
  2. Freeman R. Autonomic peripheral neuropathy. The Lancet. 2005;365:1259.
  3. Stevens MJ. Diabetic autonomic neuropathy. http://www.uptodate.com/index. Accessed May 25, 2012.
  4. Boulton AJM, et al. Diabetic neuropathies: A statement from the American Diabetes Association. Diabetes Care. 2005;28:956.
  5. Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9146961. Accessed May 25, 2012.
  6. Diabetic neuropathies: The nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/. Accessed May 21, 2012.
  7. Overview of the autonomic nervous system. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/neurologic_disorders/autonomic_nervous_system/overview_of_the_autonomic_nervous_system.html. Accessed May 25, 2012.
  8. Philips JC, et al. Squatting, a posture test for studying cardiovascular autonomic neuropathy in diabetes. Diabetes & Metabolism. 2011;37:489.
  9. Bethanechol (prescribing information). Pomona, N.Y.: Barr Laboratories, Inc.; 2007. http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=80ee6156-18b8-45aa-9402-b40647173da8. Accessed May 25, 2012.
  10. Detrol (prescribing information). New York, N.Y.: Pharmacia and Upjohn; 2012. http://labeling.pfizer.com/ShowLabeling.aspx?id=719. Accessed May 25, 2012.
  11. Ditropan (prescribing information). Raritan, N.J.: Ortho McNeil Pharmaceuticals; 2011. http://www.janssenpharmaceuticalsinc.com/assets/ditropanxl.pdf. Accessed May 25, 2012.
  12. Vinik AI, et al. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387.
  13. Robinul and Robinul Forte (prescribing information). Atlanta, Ga.: Shionogi Pharma, Inc.; 2010. http://www.robinul.com/Robinul%20PI.pdf. Accessed May 25, 2012.
  14. Shakher J, et al. Update on the management of diabetic polyneuropathies. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011;4:289.
  15. Wang CP, et al. A single-blinded, randomized pilot study evaluating effects of electroacupuncture in diabetic patients with symptoms suggestive of gastroparesis. The Journal of Alternative and Complementary Medicine. 2008;7:833.
  16. Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. May 29, 2012.
DS00544 July 12, 2012

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