Ephedrine: a new treatment for diabetic neuropathic oedema

Peripheral oedema secondary to diabetic neuropathy is poorly understood and difficult to treat. Ephedrine markedly reduced neuropathic oedema in four insulin-dependent diabetics. Mean weight-loss (p less than 0 . 05) after 7 days' treatment was 7 . 43 +/- 4 . 51(SD) kg. The oedema returned (mean weight increase 6 . 33 +/- 1 . 73 kg; p less than 0 . 01) when ephedrine was withdrawn but resolved (weight-loss 4 . 85 +/- 1 . 57 kg; p less than 0 . 01) when ephedrine treatment was repeated. In one patient mean 24 h sodium excretion increased from 177 +/- 5 . 20 mmol before ephedrine to 502 +/- 78 mmol on ephedrine therapy (p=0 . 028). Ephedrine also reduced excessive peripheral blood flow produced by the neuropathy; both arterial diastolic flow and arteriovenous shunting as demonstrated by Doppler blood velocity profiles were reduced and the pulsatility index increased from 2 . 50 +/- 0 . 61 to 4 . 75 +/- 1 . 76 (p less than 0 . 001). Ephedrine continues (12-15 months) to be an effective treatment for neuropathic oedema in these four patients.