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Alpha Liopic Acid Injection

Alpha lipoic acid (ALA, thioctic acid) is an antioxidant associated with the treatment of glaucoma, alcoholic liver disease, diabetes mellitus, diabetic neuropathy, dementia secondary to Alzheimer's disease or human immunodeficiency virus (HIV) infection, and amanita mushroom poisoning. Most studies supporting the use of ALA for diabetes and diabetic neuropathy took place over a short time (three to five weeks) and involved a small sample of patients, but some studies as long as six months and 24 months have also been completed and are available. In Germany, ALA has been used extensively in the treatment of diabetic neuropathy since 1959. For other purported indications (specifically Alzheimer’s disease, HIV-related dementia, and liver disease), studies of ALA have been lacking or inconclusive. Until stronger studies are available, ALA cannot be recommended for these indications.

Mechanism of Interaction

Endogenous alpha lipoic acid is available as both an R- and S- enantiomer. Most human clinical trials have used a racemic mixture, though the R-enantiomer is the biologically active component. ALA is rapidly absorbed and distributed into tissues via oral or intraperitoneal administration. Affected tissues and organs include the heart, liver, and skeletal muscle. Within these tissues, ALA is readily reduced to dihydrolipoic acid (DHLA). ALA and DHLA are both water and fat soluble, and ALA is metabolized almost entirely; very little is excreted unchanged. ALA and DHLA are both potent antioxidants that can engage with reactive and chelate metals (iron and copper for ALA and cadmium for DHLA), and ALA is natural cofactor of mitochondrial dehydrogenase complexes. DHLA may also be able to regenerate oxidized vitamins E and C and glutathione.

Diabetes mellitus type 2: Preliminary, short-term studies suggest that ALA may increase insulin sensitivity in patients with type 2 diabetes mellitus; ALA has been shown to increase skeletal muscle glucose uptake and glucose disposal, improving insulin sensitivity and glucose utilization in patients with this condition.

Diabetic neuropathy: Oxidative stress and lipid peroxidation are known causes of neuropathic pain and dysfunction. ALA has been shown to improve the symptoms of neuropathy in patients with diabetes; a meta-analysis of four trials involving intravenous ALA administered daily for three weeks associates ALA with a significant improvement in total symptom scores including pain, burning, and numbness. Improvements have also been noted in neuropathic impairment scores including pin-prick sensation, touch-pressure sensation, and ankle reflexes.

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