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Advances in Understanding Drug-Induced Neuropathies

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Abstract

Many commonly used medications have neurotoxic adverse effects; the most common of these is peripheral neuropathy. Neuropathy can be a dose-limiting adverse effect for many medications used in life-threatening conditions, such as malignancy and HIV-related disease. Epidemiological evidence supports previous case reports of HMG-CoA reductase inhibitors (or ‘statins’) causing an axonal sensorimotor neuropathy or a purely small-fibre neuropathy in some patients. The neuropathy improves when the medication is withdrawn. Despite the association between HMG-CoA reductase inhibitors and neuropathy, the risk is low compared with the significant vascular protective benefits. Oxaliplatin, a new platinum chemotherapy agent designed to have fewer adverse effects than other such agents, has been shown to cause a transient initial dysaesthesia in addition to an axonal polyneuropathy. Thalidomide, an old therapy currently being utilised for new therapeutic indications (e.g. treatment of haematological malignancies), is associated with a painful, axonal sensorimotor neuropathy that does not improve on withdrawal of the drug. Nucleoside reverse transcriptase inhibitors are important components of highly active antiretroviral therapy, but are associated with a sensory neuropathy that is likely to be due to a direct effect of these drugs on mitochondrial DNA replication. New research demonstrates that lactate levels may help discriminate between neuropathy caused by nucleoside analogues and HlV-induced neuropathy. Understanding the mechanism of drug-induced neuropathy has led to advances in preventing this disabling condition.

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Acknowledgements

The authors would like to thank Ms Denice Janus for secretarial assistance. The authors were supported in part by NIH NS42056, The Juvenile Diabetes Research Foundation Center for the Study of Complications in Diabetes (JDRF), Office of Research Development (Medical Research Service), Department of Veterans Affairs (JWR) and NIH T32 NS07222 (ACP). The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Department of Neurology, University of Michigan, 200 Zina Pitcher Place, 4410 Kresge III, Ann Arbor, Michigan, 48109-0585, USA

    Amanda C. Peltier &  James W. Russell

  2. Department of Neurology, Veterans Affairs Medical Center, Ann Arbor, Michigan, USA

    James W. Russell

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  1. Amanda C. Peltier
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Peltier, A.C., Russell, J.W. Advances in Understanding Drug-Induced Neuropathies. Drug-Safety 29, 23–30 (2006). https://doi.org/10.2165/00002018-200629010-00002

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