PAIN

Myalgia, arthralgia, headaches, etc. are treated with analgesics and nonsteroidal anti-inflammatory drugs (paracetamol, ibuprofene, aspirin, indomethacin…).

PRURITUS

Ciguatera pruritus is generally releaved with pure H1 type antihistamine drugs: dexchlorphéniramine (Polaramine®…), mixed H1 type antihistamines: cyproheptadine (Periactin®…), hydroxyzine (Atarax®); cetirizine (Virlix®) and local anesthetics (lidocaine...).

Toutefois, leur efficacité reste réduite, compte tenue de l'origine neurologique du prurit rencontré dans la ciguatéra.

PERIPHERAL NEUROPATHIES AND ASTHENIA

A multivitamin cocktail of vitamins B (B1, B6, B12) and C associated with calcium gluconate is frequently suggested, although its efficacy has not been officially proved. In the acute phase, the treatment consists of a slow IV infusion (1h) of a glucose solution (250ml), containing 1g of vitamin C, 250mg of vitamin B6 and 1g of calcium gluconate.

It has been shown that vitamin B12 active form (methylcobalamin), when administered at high doses, stimulates regeneration of damaged neural structures. Vitamins B are usually known for their neuroprotective properties. Vitamin C, is used for its anti-asthenic properties and as a chelator of free radicals. Finally, calcium salts are used, as a calcium rich medium, causes a decreased affinity of ciguatoxins for their receptors.

CHRONIC PARESTHESIA AND DYSESTHESIA

Amitriptyline (Laroxyl®, Elavil®) and gabapentin (Neurontin®) are recommended for the relief of chronic paresthesia and dysesthesia. Indeed, amitriptyline administered at a dose of approximately 50mg once a day, has shown significant improvements (of neurological symptoms, and even pruritus) in some patients.

Finally, cholestyramine (Questran®…), an anticholesteremic, which seems to have a ciguatoxins-antagonist activity, demonstrated some efficiency on neurological symptoms improvement in numerous patients.

CHRONIC FATIGUE

It has been demonstrated that fluoxetine (Prozac®), a selective serotonin reuptake inhibitor used as antidepressant drug, leads to a significant improvement of the chronic fatigue syndrome associated with CP.