Epalrestat is an aldose reductase inhibitor. Since its approval in Japan in 1992, it has been widely used as an adjuvant treatment for diabetic peripheral neuropathy.

What are the Precautions for Taking Epalrestat?

Medication Administration and Dosage Form Specifications

Epalrestat is available as white film-coated tablets, which must be swallowed whole.

If the medication comes in PTP aluminum foil packaging, patients must be instructed to remove the tablets from the foil before taking them.

Accidental ingestion of the aluminum foil may cause damage to the esophageal mucosa or even esophageal perforation, which must be strongly emphasized when dispensing the medication.

Dosage and Target Population

Standard dosage for adults: 50mg each time, three times a day, to be taken orally before each meal. The dosage may be appropriately adjusted based on the patient's age and symptoms.

Contraindications and cautious use: It is not suitable for diabetic patients who have developed irreversible organic lesions. If no significant therapeutic effect is observed after 12 consecutive weeks of medication, the treatment plan should be changed immediately.

Management of special populations: Pregnant women should use this medication only when the therapeutic benefits outweigh the potential risks. Lactating women need to weigh the necessity of medication, as animal studies have shown that the drug can be excreted in breast milk.

Prevention of Adverse Reactions

Common side effects include abdominal pain, nausea, skin rashes, or abnormal liver function indicators.

During the medication period, close attention should be paid to severe side effects, such as thrombocytopenia (frequency unknown) and severe hepatitis, liver failure (frequency < 0.1%).

If symptoms such as skin rashes, itching, or jaundice occur, the medication should be discontinued immediately and medical attention sought promptly.

Medication Monitoring for Epalrestat

Efficacy and Tolerability Assessment

Monitoring of symptom improvement: Record changes in neuropathic symptoms such as limb pain and numbness after medication. If no improvement is seen within 12 weeks, the treatment plan needs to be re-evaluated.

Central nervous system and digestive system reactions: Pay attention to symptoms such as dizziness, fatigue, abdominal pain, and nausea. Especially for elderly patients, regular assessments of cognitive function and gastrointestinal function are required.

Tracking of Safety Indicators

Liver function and hematological monitoring: Regularly test levels of AST, ALT, γ-GTP, and bilirubin, and monitor for the occurrence of anemia or leukopenia.

Renal function and metabolic indicators: A small number of patients may experience an increase in BUN and creatinine levels or a decrease in urine output. The medication dosage should be adjusted based on clinical symptoms.

Dynamic Management of Special Populations

Patients with hepatic or renal impairment: Although specific guidelines are not clearly stated in the package insert, based on the drug's metabolic characteristics (mainly excreted in urine), the risk of drug accumulation must be guarded against.

Patients on long-term medication: Note that urine may turn yellowish-brown or red. This phenomenon may interfere with the test results of urinary bilirubin and ketone bodies, so the laboratory department should be informed in advance.