[3 ,7] In order to further evaluate phenytoin cream in CIAP patients we started preparing a full powered cross-over RCT in CIAP patients, together with colleagues of the Medical Academic Centre in Utrecht. [3] Phenytoin cream can be used in combination with other therapies or as a stand-alone therapy.In CIAP patients suffering from neuropathic pain, one of the pain characteristics mostly present is burning, suggestive for the involvement of a small fiber component. Sometimes this neuropathy is referred to as cryptogenic neuropathy. We selected phenytoin for compounding in a topical vehicle due to its profile as a broad acting archetypical sodium channel blocker and based on its remarkable properties as a repositioned multi-purpose drug. From January 2017 until June 2017 4.5 kilo of phenytoin 5% cream (corresponding to 150 tubes of 30 grams) and 26 kilo of phenytoin 10% cream (corresponding to 866 tubes of 30 gram) are compounded by the Dutch pharmacists related to the Institute of Neuropathic Pain, and sent to patients for the treatment of neuropathic pain (see graph). [4] Most patients explain they feel the burning pain in the skin, such as sun burn, which was for us a pointer to develop topical formulations containing analgesics. Meanwhile, we use this single-blind response test always before we prescribe phenytoin cream, to rule out placebo-responders already during the first visit. pharmaceuticals Article Phenytoin Cream for the Treatment of Neuropathic Pain: Case Series David J. Kopsky 1,* ID and Jan M. Keppel Hesselink 2 ID 1 Institute for Neuropathic Pain, Vespuccistraat 64-III, 1056 SN Amsterdam, The Netherlands 2 Institute for Neuropathic Pain, Spoorlaan 2a, 3735 MV Bosch en Duin, The Netherlands; jan@neuropathie.nu * Correspondence: info@neuropathie.nu; Tel. [3, 7] In these patients, pain reduction on the phenytoin cream applied area was significantly more pronounced than at the placebo cream applied area.
[6, 7]A man of 56 years old, started to have symptoms of restless legs many years ago, treated with pramipexol 0.125 mg twice daily and temazepam 10 mg once daily. In order to help those patients, we developed a treatment-regime consisting of the supplement palmitoylethanolamide and topical formulations of analgesics. One of our most recent topical formulation we developed contains 10% phenytoin, a broad acting voltage-gated sodium-channel blocker. The symptoms experienced by the patient with neuropathic pain differ from those experienced by patients with acute pain. However the cream provided temporary relief for the patients cited above.“Dilantin (phenytoin) is a hydantoin anticonvulsant that is commonly used for the management of epileptic seizures.”“In MS patients, it is used for pain management to reduce painful sensations caused by demyelination in the sensory pathways in the brain and spinal cord.”However the topical cream avoids the many harmful side effects which present themselves when the drug travels throughout the entire body.Phenytoin isn’t sold over-the-counter, and must be prescribed by a licensed doctor. After 30 min, you will tell us whether there is a difference in pain scoring on the NRS, and based on your evaluation we know what best to prescribe you.â [7] Within 20 minutes after application the patient clearly felt the difference: while the pain in the right foot remained more or less the same, pain in the left foot was reduced from 7 to 2 as scored on the NRS. In a video, uploaded at YouTube, the patient explains the effect of phenytoin 10% cream, which makes this case report more vivid.Chronic idiopathic axonal polyneuropathy (CIAP) is a progressive sensory or sensorimotor polyneuropathy that affects elderly patients. Before prescribing a topical analgesic cream, we conducted a single-blind placebo-controlled response test (SIBRET), applying placebo-cream on the right foot, and phenytoin 10% cream on the left foot (Figure 1). For one year, he experienced burning feet, cramps in leg muscles, and sensibility disturbances in both feet (walking on cotton). Many CIAP patients complain of intolerable side effects of current analgesic medication. Keywords: phenytoin, topical administration, neuropathic pain… Opioids may provide a degree of relief, but only at doses impractical for what may become lifelong therapy. In the case described above, the patient could correctly identify the active cream within a time-frame of 20 minutes.Since our first introduction of the cream, we have treated hundreds of patients, most of those successfully, and we reported a series of 12 and 21 patients recently, based on SIBRET. Keppel Hesselink JM, Kopsky DJ (2018) Neuropathic pain due to chronic Idiopathic Axonal Neuropathy: Fast pain reduction after topical phenytoin cream application. This study will provide further answers of the value of phenytoin cream for pain patients due to CIAP, and will analyze the contribution of the response-test to identify responders.The authors patent holders of two patents related to the topical formulations of phenytoin in the treatment of pain: 1) Topical phenytoin for the use in the treatment of peripheral neuropathic pain and 2) Topical pharmaceutical composition containing phenytoin and a (co-) analgesic for the treatment of chronic pain. Since the sensory nerves reach the stratum granulosum, the upper most layer with living keratinocytes in the epidermis, active substances only need to cross the stratum corneum to influence the overactive sensory nerves. This combination is rarely complicated by side effects.
[6, 7]A man of 56 years old, started to have symptoms of restless legs many years ago, treated with pramipexol 0.125 mg twice daily and temazepam 10 mg once daily. In order to help those patients, we developed a treatment-regime consisting of the supplement palmitoylethanolamide and topical formulations of analgesics. One of our most recent topical formulation we developed contains 10% phenytoin, a broad acting voltage-gated sodium-channel blocker. The symptoms experienced by the patient with neuropathic pain differ from those experienced by patients with acute pain. However the cream provided temporary relief for the patients cited above.“Dilantin (phenytoin) is a hydantoin anticonvulsant that is commonly used for the management of epileptic seizures.”“In MS patients, it is used for pain management to reduce painful sensations caused by demyelination in the sensory pathways in the brain and spinal cord.”However the topical cream avoids the many harmful side effects which present themselves when the drug travels throughout the entire body.Phenytoin isn’t sold over-the-counter, and must be prescribed by a licensed doctor. After 30 min, you will tell us whether there is a difference in pain scoring on the NRS, and based on your evaluation we know what best to prescribe you.â [7] Within 20 minutes after application the patient clearly felt the difference: while the pain in the right foot remained more or less the same, pain in the left foot was reduced from 7 to 2 as scored on the NRS. In a video, uploaded at YouTube, the patient explains the effect of phenytoin 10% cream, which makes this case report more vivid.Chronic idiopathic axonal polyneuropathy (CIAP) is a progressive sensory or sensorimotor polyneuropathy that affects elderly patients. Before prescribing a topical analgesic cream, we conducted a single-blind placebo-controlled response test (SIBRET), applying placebo-cream on the right foot, and phenytoin 10% cream on the left foot (Figure 1). For one year, he experienced burning feet, cramps in leg muscles, and sensibility disturbances in both feet (walking on cotton). Many CIAP patients complain of intolerable side effects of current analgesic medication. Keywords: phenytoin, topical administration, neuropathic pain… Opioids may provide a degree of relief, but only at doses impractical for what may become lifelong therapy. In the case described above, the patient could correctly identify the active cream within a time-frame of 20 minutes.Since our first introduction of the cream, we have treated hundreds of patients, most of those successfully, and we reported a series of 12 and 21 patients recently, based on SIBRET. Keppel Hesselink JM, Kopsky DJ (2018) Neuropathic pain due to chronic Idiopathic Axonal Neuropathy: Fast pain reduction after topical phenytoin cream application. This study will provide further answers of the value of phenytoin cream for pain patients due to CIAP, and will analyze the contribution of the response-test to identify responders.The authors patent holders of two patents related to the topical formulations of phenytoin in the treatment of pain: 1) Topical phenytoin for the use in the treatment of peripheral neuropathic pain and 2) Topical pharmaceutical composition containing phenytoin and a (co-) analgesic for the treatment of chronic pain. Since the sensory nerves reach the stratum granulosum, the upper most layer with living keratinocytes in the epidermis, active substances only need to cross the stratum corneum to influence the overactive sensory nerves. This combination is rarely complicated by side effects.