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Treatments and drugs
By Mayo Clinic staffTreatment 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. In some cases, treating the underlying disease stops autonomic neuropathy from progressing, and the damaged nerves can even repair themselves or regenerate.
- Managing specific symptoms Beyond managing the underlying disease, other treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on which organ system is most affected by nerve damage.
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.
- Metoclopramide (Reglan). This prescription drug helps your stomach empty more rapidly 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. 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.
- Bethanechol (Urecholine). This medication helps facilitate complete emptying of the bladder. Potential side effects include headache, abdominal cramping, bloating, nausea and flushing.
- Intermittent urinary 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). 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:
- Fludrocortisone acetate (Florinef). If you get dizzy or feel faint when you stand up, this medication helps your body retain salt.
- Midodrine (ProAmatine) or pyridostigmine (Mestinon). This drug can raise your blood pressure if you get dizzy or feel faint when you stand up. High blood pressure when lying down is a possible side effect of midodrine.
- Beta blockers. This class of medications 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.
References
- Freeman R. Autonomic peripheral neuropathy. Neurologic Clinics. 2007;25:277.
- Stevens MJ. Diabetic autonomic neuropathy. http://www.uptodate.com/home/index.html. Accessed Jan. 29, 2010.
- Autonomic neuropathy. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/autonomic-neuropathy.html. Accessed Feb. 22, 2010.
- Masharani U, et al. Pancreatic hormones and diabetes mellitus. In: Gardner DG, et al. Greenspan's Basic and Clinical Endocrinology. 8th ed. New York, N.Y.: McGraw-Hill Medical; 2007. http://www.accessmedicine.com/content.aspx?aID=2633151. Accessed Feb. 22, 2010.
- 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 Feb. 21, 2010.
- Boulton AJM, et al. Diabetic neuropathies: A statement from the American Diabetes Association. Diabetes Care. 2005;28:956.
- Disorders of the autonomic nervous system. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill Medical; 2008. http://www.accessmedicine.com/content.aspx?aID=2906166. Accessed Feb. 22, 2010.
- Vink AI. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553.
- Autonomic nervous system. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch208/ch208a.html. Accessed Feb. 22, 2010.
- Ma J, et al. Diabetic gastroparesis: Diagnosis and management. Drugs. 2009;69:971.
- Bethanechol (prescribing information). Minneapolis, Minn.: Upsher-Smith Laboratories, Inc.; 2005. http://www.upsher-smith.com/PDFs/bethanechol.pdf. Accessed Feb. 22, 2010.
- Robinul and Robinul Forte (prescribing information). Atlanta, Ga.: Sciele Pharma, Inc.; 2006. http://www.shionogipharma.com/PI/Robinul%20PI.pdf. Accessed Feb. 22, 2010.
- Bansal V, et al. Diabetic neuropathy. Post Graduate Medical Journal. 2006;82:95.
- Sandroni P (expert opinion). Mayo Clinic, Rochester, Minn. March 1, 2010.
- Detrol (prescribing information). New York, N.Y.: Pharmacia and Upjohn; 2009. http://www.pfizer.com/files/products/uspi_detrol_la.pdf. Accessed March 8, 2010.
- Ditrol (prescribing information). Raritan, N.J.: Ortho McNeil Pharmaceuticals; 2008. http://www.ortho-mcneilpharmaceutical.com/sites/default/files/shared/pi/Lg%20Ditropan%20PI.pdf#zoom=100. Accessed March 8, 2010.
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