It reduces the accumulation of intracellular sorbitol which is believed to be the cause of diabetic neuropathy, retinopathy and nephropathy [2][3] It is well tolerated, with the most commonly reported adverse effects being gastrointestinal issues such as nausea and vomiting, as well as increases in certain liver enzymes.

Aldose reductase is the key enzyme in the polyol pathway whose enhanced activity is the basis of diabetic neuropathy.

[5] It is easily absorbed into the neural tissue[6] and inhibits the enzyme with minimum side effects.

[8] In a placebo controlled double blind trial of 196 patients, it was shown that Epalrestat in a dose of 150 mg/day improved the effects of diabetic neuropathy like upper limb spontaneous pain, motor nerve conduction velocity, thresholds of vibratory sensation and autonomic nerve function as compared to a placebo.

[9] A systematic review and metaanalysis showed that based on the results of 10 articles, it can be concluded that Epalrestat has some benefit in the control of diabetic cardiovascular autonomic neuropathy but only in the early or mild cases.