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Treatments and drugs
By Mayo Clinic staffThe 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. In some cases, treating the underlying disease stops autonomic neuropathy from progressing, and the damaged nerves can even repair themselves or regenerate.
Beyond managing the underlying disease, there are other treatments available to relieve the symptoms of autonomic neuropathy. Treatment is based on which organ system is most affected by nerve damage.
Gastrointestinal symptoms. Your doctor may first recommend increasing your fiber and fluid intake to relieve gastrointestinal symptoms. Your doctor may also prescribe metoclopramide (Reglan, Metoclopramide HCL), which helps your stomach empty more rapidly by increasing the contractions of the digestive tract, or tricyclic antidepressants, such as imipramine (Tofranil) or nortriptyline (Pamelor) to treat diarrhea and abdominal pain.
Urinary symptoms. If your bladder problems are mild, your doctor may recommend following a schedule of when to drink fluids, and then urinating at regular intervals to "train" your bladder. Medications such as tolterodine (Detrol) or oxybutynin (Ditropan) treat an overactive bladder, or bethanechol (Urecholine) improves complete emptying of the bladder. Antibiotics may be prescribed to clear up a urinary tract infection. A few people with autonomic neuropathy need to have intermittent urinary catheterization, a procedure in which a tube is threaded through your urethra to empty your bladder.
Sexual dysfunction. For men with erectile dysfunction, your doctor may prescribe sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis). If you're a woman with sexual symptoms, your doctor may prescribe vaginal estrogen cream (Premarin, Estrace) or vaginal estrogen rings (Estring) to improve vaginal lubrication.
Heart rhythm and blood pressure symptoms. If you get dizzy or feel faint when you stand up, your doctor may prescribe fludrocortisone acetate (Florinef), which helps your body retain salt, or a blood pressure regulator such as midodrine (ProAmatine). If your heart rate doesn't respond normally to changes in activity level, your doctor may prescribe beta blockers to regulate the heart rate. A high-salt, high-fluid diet may help if you experience a racing heartbeat when you stand up.
Sweating. If you experience excessive sweating, your doctor may prescribe a medication that decreases sweating, such as glycopyrrolate (Ribinul, Robinul Forte) or clonidine (Catapres).
