07/17/2015    Michael M. Rosenblatt, DPM

Medications to Consider for Neuropathy

I have some concerns about a DPM (or for that
matter any physician) who wants to add
medications to an unrepentant smoker with
serious, disabling neuropathy. One of the
medications he takes is Trazadone, a serotonin
modulator that has suicidal and violent ideation
as just some of its side-effects. Although this
is more common in younger patients, we already
know the patient is depressed. But there are
more:

Sertraline (Zoloft) also has similar side effects
and concerns. Oxcarbazepine is usually used to
treat seizure disorders, but also includes
bipolar disorders. Gabapentin is also used to
treat mood disorders. By any metric you choose,
this patient is under a large cocktail of potent
mood-altering drugs, each loaded with side
effects. He is probably seriously over-medicated.
And he may also be drinking alcohol!

Adding another drug to this list will not improve
his neuropathy or his mood. Worse, any addition
is likely to have an additive effect on the drugs
he is already taking, and may cause him to have
completely unanticipated side-reactions. As a
DPM, you are obligated to understand any drugs
you prescribe, and be responsible for their side
effects and drug interactions.

What you CAN do is ask him to sign a waiver
explaining that his smoking will likely make his
condition much worse and result in amputations
and even his death. He will refuse to sign it.
You can then have a member of your staff co-sign
the form and record that refusal. There is
nothing you can do for him. Right now it is time
for you to protect yourself.

Michael M. Rosenblatt, DPM, (Retired),
San Jose, CA

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