When adding an agent, it's best to prescribe a drug that has a different method of action rather than just adding another similar drug, Dr. Cole said. “We're looking for the synergistic effect, not the additive effect. We hope 1 plus 1 will equal 3.”
The guidelines will be a valuable resource not only for neurologists, but also for family physicians, internists, and psychiatrists, all of whom are called upon to treat DPNP in a busy clinical practice—a venue that makes it tough to give these patients the time and attention they need, he said.
“Pregabalin and duloxetine are very easy to work with,” Dr. Cole said. “They have one starting dose; you follow an easy progression of titration, and within 2–4 weeks, you know if it's going to be effective. It doesn't take 6 months to know if you're on the right track, and that's very helpful for a busy clinician.”
Dr. Cole receives honoraria from Eli Lilly & Co. and Endo Pharmaceuticals.