Medications That Can Cause Facial Palsy
While the provided evidence focuses primarily on treating Bell's palsy rather than drug-induced facial palsy, the literature does not identify antibiotics, antivirals, immunosuppressants, or corticosteroids (including prednisone) as causes of facial nerve paralysis. In fact, corticosteroids are the cornerstone treatment for Bell's palsy, not a cause of it 1, 2.
Key Clinical Context
The evidence provided addresses Bell's palsy management extensively but does not list medications as causative agents for facial nerve paralysis 1, 2. The American Academy of Otolaryngology-Head and Neck Surgery emphasizes that clinicians must assess patients using history and physical examination to exclude identifiable causes of facial paresis or paralysis, which include 1, 2:
- Trauma (temporal bone fracture, surgical injury) 2
- Infection (acute otitis media, Ramsay Hunt syndrome) 2, 3
- Tumor 2
- Stroke (distinguished by forehead sparing in central lesions) 2
Medications Used to TREAT (Not Cause) Facial Palsy
The evidence clearly demonstrates that certain medications are therapeutic, not causative 1, 2:
Corticosteroids (Therapeutic)
- Prednisone 60 mg daily for 5 days followed by 5-day taper or prednisolone 50 mg daily for 10 days should be prescribed within 72 hours of Bell's palsy onset for patients 16 years and older 2, 4
- Evidence shows 83% recovery at 3 months with prednisolone versus 63.6% with placebo 2, 5
Antivirals (Limited Therapeutic Role)
- Antivirals alone should NOT be prescribed for Bell's palsy as monotherapy is ineffective 2, 4
- Combination therapy with antivirals plus corticosteroids may offer modest benefit (96.5% complete recovery versus 89.7% with steroids alone) 6, 7
- Acyclovir 400 mg five times daily for 10 days can be used in combination with steroids 2
Common Pitfall to Avoid
Do not confuse medications used to treat Bell's palsy with medications that cause facial palsy. The evidence provided does not support that antibiotics, antivirals, immunosuppressants, or corticosteroids cause facial nerve paralysis 1, 2, 3. When facial palsy occurs, these medications (particularly corticosteroids) are the primary treatment, not the etiology 1, 2, 4.
When to Suspect Alternative Diagnoses
Features atypical of Bell's palsy that require imaging and specialist evaluation include 2:
- Second paralysis on the same side
- Isolated branch paralysis (not affecting entire hemifacial distribution)
- Other cranial nerve involvement
- Bilateral facial weakness (rare in Bell's palsy)
- No recovery after 3 months