ALA

• Approved Indications:
• Adjunctive treatment for diabetic peripheral neuropathy to reduce symptoms such as burning, pain, and paresthesia.
• Management of oxidative stress-related conditions due to its antioxidant properties.
• Clinically Accepted Off-label Uses:
• Supportive therapy in chronic liver diseases and non-alcoholic fatty liver disease (NAFLD).
• Potential benefit in neurodegenerative diseases such as Alzheimer’s disease (investigational).
• Adjunct in metabolic syndrome and insulin resistance management.
• Use in cardiovascular diseases for endothelial function improvement.
• Support in weight management and anti-aging regimens.

• Adults:
• Oral: Typical dose ranges from 300 mg to 600 mg daily, often divided into two doses (e.g., 300 mg twice daily).
• For diabetic neuropathy, 600 mg daily orally or intravenous administration (600 mg IV daily for 3 weeks) may be used.
• Elderly:
• No specific dose adjustment needed; monitor for tolerance.
• Pediatrics:
• Safety and efficacy not well established; use cautiously if at all.
• Renal/Hepatic Impairment:
• No formal dose adjustments; use cautiously with monitoring in severe impairment.
• Route: Oral capsules/tablets or intravenous infusion for acute management.

Alpha Lipoic Acid is a naturally occurring antioxidant that acts as a cofactor for mitochondrial enzyme complexes involved in oxidative metabolism. It exerts its therapeutic effects primarily through scavenging reactive oxygen species (ROS) and regenerating other antioxidants such as vitamins C and E and glutathione. By reducing oxidative stress, ALA protects nerve cells from damage and improves mitochondrial function, which contributes to its neuroprotective and anti-inflammatory effects. Additionally, ALA enhances glucose uptake in peripheral tissues by improving insulin sensitivity, thereby aiding glycemic control.

• Absorption: Rapidly absorbed orally; bioavailability varies widely (approximately 20–40%) due to extensive first-pass metabolism.
• Distribution: Widely distributed in body tissues, crossing the blood-brain barrier.
• Metabolism: Undergoes extensive hepatic metabolism via reduction and conjugation pathways.
• Half-life: Approximately 30 minutes to 1 hour; shorter for the oral form due to rapid clearance.
• Elimination: Mainly renal excretion of metabolites; small amounts excreted unchanged.

• Pregnancy:
  Classified as FDA Category C. Animal studies have shown no teratogenic effects, but controlled human studies are lacking. Use only if benefits justify potential risks.
• Lactation:
  Data on excretion into breast milk are lacking; caution advised. Breastfeeding not recommended unless benefits outweigh risks.

• Primary Class: Antioxidant
• Subclass: Mitochondrial Cofactor and Neuroprotective Agent

• Known hypersensitivity to alpha lipoic acid or any excipients
• Caution in patients with thyroid disorders as ALA may affect thyroid hormone levels
• Not recommended in patients with severe thiamine deficiency without supplementation

• Use with caution in patients with autoimmune diseases due to potential immune modulation
• Monitor blood glucose closely in diabetic patients as ALA may enhance insulin action and cause hypoglycemia
• Rare risk of allergic reactions, including rash and anaphylaxis
• Use cautiously in patients with severe renal impairment

• Common:
• Gastrointestinal discomfort (nausea, vomiting, abdominal pain)
• Headache
• Skin rash or pruritus
• Metallic taste
• Rare:
• Hypoglycemia (especially when combined with antidiabetic drugs)
• Allergic reactions (urticaria, angioedema)
• Peripheral neuropathy worsening (rare)
• Onset and Severity:
  Side effects are generally mild and transient; hypoglycemia risk is dose-dependent.

• May potentiate hypoglycemic effects of insulin and oral antidiabetic agents
• Possible interaction with thyroid hormone replacement therapy
• No significant CYP450 enzyme interactions reported
• No major interactions with food or alcohol documented

• Growing evidence supports the use of ALA in diabetic neuropathy management with updated guidelines recommending it as an adjunctive antioxidant therapy.
• Research is ongoing regarding its neuroprotective role in neurodegenerative disorders.
• No major changes in dosing or safety warnings recently reported by regulatory authorities.

• Store at 20°C to 25°C (68°F to 77°F) in a dry place
• Protect from light and moisture
• Keep container tightly closed
• Do not freeze