Serotonin-Norepinephrine Reuptake Inhibitors for the Management of Chemotherapy-Induced Peripheral Neuropathy

1. May T. Aziz, PharmD, BCPS1,2
2. Brittany L. Good, PharmD1
3. Denise K. Lowe, PharmD, BCPS1,2

1. ¹Virginia Commonwealth University Health System/Medical College of Virginia Hospitals, Richmond, VA, USA
2. ²Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA

1. May T. Aziz, PharmD, BCPS, Virginia Commonwealth University School of Pharmacy, 401 N 12th Street, PO Box 980042, Richmond, VA 23298-0042, USA. Email: maziz@mcvh-vcu.edu

Abstract

Objective: To review the literature evaluating serotonin-norepinephrine reuptake inhibitors (SNRIs) for chemotherapy-induced peripheral neuropathy (CIPN). Data Sources: A PubMed search (1966-January 2014) was performed using the key terms serotonin-norepinephrine reuptake inhibitor, desvenlafaxine, duloxetine, milnacipran, venlafaxine, chemotherapy, and peripheral neuropathy. Bibliographies of select articles were examined for additional references and abstracts. Study Selection and Data Extraction: Case reports and clinical trials published in English and conducted in humans were identified. All reports and trials evaluating a SNRI for the treatment of CIPN were included; 4 case reports, 1 open-label study, and 2 randomized controlled trials were identified for review.  

Data Synthesis: At present, no medications are approved for the treatment for CIPN. Emerging evidence suggests that venlafaxine and duloxetine may be effective for treating CIPN. Results of select trials report that these medications not only decrease pain but also relieve symptoms of numbness and tingling and improve the functional status and quality of life of patients suffering from CIPN.  

Conclusions: Evidence to support venlafaxine and duloxetine for the treatment of CIPN from oxaliplatin- or paclitaxel-based regimens is promising. Unfortunately, direct comparisons between venlafaxine and duloxetine do not exist, so definitive conclusions about which agent is preferred cannot be made. However, the breadth of data with duloxetine is larger, suggesting that it may be prudent to consider duloxetine first when choosing a SNRI for CIPN treatment. 

More robust trials are needed to establish their optimal place in therapy with regard to patient population, timing of therapy, dosing, and treatment duration.