From the Guidelines
Several medications can potentially cause neuropathy as a side effect, with chemotherapy drugs being the most common, including taxanes, platinums, vinca alkaloids, epothilones, eribulin, and bortezomib, as reported in the most recent study 1. The most common medications that can cause peripheral neuropathy include:
- Chemotherapy drugs (e.g., paclitaxel, oxaliplatin)
- Antiretroviral medications for HIV (e.g., stavudine, didanosine)
- Antibiotics (e.g., metronidazole, fluoroquinolones like ciprofloxacin)
- Cardiovascular medications (e.g., amiodarone, hydralazine)
- Antiseizure drugs (e.g., phenytoin)
- Some antidepressants (e.g., amitriptyline at high doses) The risk of developing neuropathy often depends on the dose and duration of treatment, with chemotherapy-induced neuropathy occurring within weeks of starting treatment, as noted in 1 and 1. If you're experiencing symptoms of neuropathy (numbness, tingling, burning sensations, or weakness in extremities), consult your doctor immediately, as they may adjust your medication dose, switch to an alternative drug, or provide treatments to manage symptoms, as suggested in 1. The mechanism by which these medications cause neuropathy varies, with some directly damaging nerve fibers, while others interfere with nerve function or blood supply to nerves, as discussed in 1 and 1. Understanding the specific mechanism can help in prevention and management strategies. It is essential to prioritize the management of peripheral neuropathy to minimize its impact on morbidity, mortality, and quality of life, as emphasized in the most recent guideline update 1.
From the FDA Drug Label
Neurologic problems including weakness of your legs, feet, arms, or hands (motor weakness) and numbness, tingling or pain in your hands or feet (peripheral neuropathy) Peripheral neuropathy can be common and severe, and happens more often in people who have advanced HIV-1 disease, have a history of peripheral neuropathy, or in people who take other medicines that can cause peripheral neuropathy. Peripheral neuropathy, manifested by numbness, tingling, or pain in the hands or feet, has been reported in patients receiving didanosine therapy. Peripheral neuropathy has occurred more frequently in patients with advanced HIV disease, in patients with a history of neuropathy, or in patients being treated with neurotoxic drug therapy, including stavudine
The medications that can cause peripheral neuropathy are:
- Stavudine
- Didanosine
- Hydroxyurea (when used in combination with didanosine and stavudine)
- Other neurotoxic drug therapy 2, 3, 3
From the Research
Medications that can Cause Peripheral Neuropathy
The following medications have been implicated in the development of peripheral neuropathy:
- Chemotherapeutic agents, such as taxanes, vinca alkaloids, and bortezomib 4, 5, 6, 7, 8
- Antimicrobials 4
- Cardiovascular drugs, including statins 4
- Psychotropic drugs 4
- Anticonvulsants 4
- Certain antidepressants, such as duloxetine, which can be used to treat peripheral neuropathy but may also cause it in some cases 4, 5, 7
Mechanisms of Peripheral Neuropathy
The mechanisms by which these medications cause peripheral neuropathy are complex and involve:
- Direct damage to mitochondria 7, 8
- Impairment of ion channels 7, 8
- Triggering of immunological mechanisms 7
- Disruption of microtubules 7
- DNA damage and alterations in cellular system repairs 8
- Increased intracellular reactive oxygen species 8
- Alterations in glutamate signaling, MAP-kinases, and nociceptors ectopic activation 8
Treatment and Prevention
While there are no approved pharmacological options for the prevention or treatment of chemotherapy-induced peripheral neuropathy, several medications and therapies have shown promise, including: