Medications that cause neuropathy
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Medications That Cause Neuropathy
Peripheral neuropathy, a condition characterized by pain, numbness, and weakness, can be induced by various medications. Understanding which drugs are commonly associated with this condition is crucial for healthcare providers to prevent and manage drug-induced peripheral neuropathy (DIPN).
Chemotherapeutic Agents and Neuropathy
Chemotherapy-Induced Peripheral Neuropathy (CIPN)
Chemotherapeutic agents are among the most common culprits of drug-induced neuropathy. Drugs such as cisplatin, oxaliplatin, paclitaxel, vincristine, and bortezomib are effective in treating cancers but often cause severe peripheral neurotoxicity . These agents can lead to structural deficits in the dorsal root ganglia and sensory nerves, resulting in symptoms like sensory loss, paresthesia, and dysesthesia. The neurotoxic effects are dose-dependent and can limit the continuation of life-saving therapies.
Antimicrobials and Neuropathy
Antibiotics and Antiviral Drugs
Certain antibiotics and antiviral drugs are also known to cause neuropathy. For instance, the antibiotic linezolid and nucleoside reverse transcriptase inhibitors (NRTIs) used in HIV treatment can lead to peripheral neuropathy . NRTIs affect mitochondrial function, leading to depletion of mitochondrial DNA and inhibition of DNA polymerase, which may contribute to the development of neuropathy.
Cardiovascular Drugs and Neuropathy
Statins and Neuropathy
The relationship between statins and neuropathy is controversial. While some studies suggest that statins may have neuroprotective effects, others indicate that they can cause neuropathy, particularly in patients with preexisting risk factors . The large Fremantle Diabetes Study suggested potential neuroprotective effects, but the debate continues.
Psychotropic and Anticonvulsant Drugs
Psychotropic Medications
Psychotropic drugs, including certain antidepressants and antipsychotics, have been implicated in causing neuropathy. Tricyclic antidepressants (TCAs) like amitriptyline, although effective for neuropathic pain, can have side effects that include neuropathy .
Anticonvulsants
Anticonvulsants such as gabapentin and pregabalin are commonly used to treat neuropathic pain but can also cause neuropathy in some cases . These drugs are often part of the treatment regimen for diabetic peripheral neuropathy (DPN) and other neuropathic conditions .
Other Medications
Tumor Necrosis Factor-α Blockers and Immunosuppressants
Drugs like infliximab and etanercept, used to treat inflammatory arthritis, and immunosuppressants like tacrolimus, used in transplant patients, have been associated with neuropathy . Tacrolimus, in particular, can cause a demyelinating neuropathy that may mimic conditions like Guillain-Barré syndrome.
Emerging Drugs and Neuropathy
Newer drugs, such as the anticancer agents bortezomib and ixabepilone, have also been linked to neuropathy. Additionally, dichloroacetate, used for lactic acidosis-associated disorders, is another agent where neuropathy is a treatment-limiting factor.
Conclusion
Drug-induced peripheral neuropathy is a significant and often challenging condition to manage. Chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic medications, and anticonvulsants are among the most common medications associated with neuropathy. Awareness and early recognition of these potential side effects are crucial for healthcare providers to prevent and manage DIPN effectively. Further research is needed to develop neuroprotective strategies and improve treatment outcomes for patients affected by this condition.
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