Duloxétine (Cymbalta®) et son utilisation dans le traitement de la neuropathie diabétique douloureuse

Neuropathic pain is a common problem in our society, affecting nearly 1.5% of the population. Currently, there are six medications approved for the treatment of neuropathic pain, which include tricyclic agents (amitriptyline, imipramine, clomipramine), gabapentin, pregabalin, duloxetine, lidocaine patch and carbamazepine. Duloxetine hydrochloride is a combined serotonin (5-hydroxytryptamine) and noradrenaline reuptake inhibitor used to treat depression, generalized anxiety disorder, painful neuropathy (as painful diabetic neuropathy, PDN). This article discusses in detail the specificities of this agent. Duloxetine is effective for the treatment of PDN, judged by the outcome of at least 50% pain relief over 12 weeks, and is well tolerated. However the introduction of duloxetine (Cymbalta®) in the field of diabetic neuropathic pain leads to three questions regarding: the specificities of the diabetic neuropathic pains, the therapeutic strategy and the contribution of duloxetine in the treatment of PDN. In France, duloxetine is the only drug approved by Health authorities with the specific indication “Treatment of painful diabetic peripheral neuropathy in adults”.