Epalrestat is aldose reductase inhibitor. The aldose reductase inhibitors have a distinct mechanism of action, affecting the underlying disease process in diabetic neuropathy, although the extent of the polyol pathway involvement is yet to be determined. Epalrestat reduces sorbitol accumulation in the sciatic nerve, erythrocytes. Epalrestat may improve motor and sensory nerve conduction velocity and subjective neuropathy symptoms.