Drug-Induced Peripheral Neuropathy: A Narrative Review

Abstract

Background: Peripheral neuropathy is a painful condition deriving from many and varied etiologies. Certain medications have been implicated in the iatrogenic development of Drug Induced Peripheral Neuropathy (DIPN) and include chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, anticonvulsants, among others. This review synthesizes current clinical concepts regarding the mechanism, common inciting medications, and treatment options for drug-induced peripheral neuropathy. Methods: The authors undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The most relevant and up to date research was included. Results: Drug-induced peripheral neuropathy is a common and painful condition caused by many different and frequently prescribed medications. Most often, DIPN is seen in chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, and anticonvulsant drugs. Certain drugs exhibit more consistent neuropathic side effects, such as the chemotherapeutic compounds, but others are more commonly prescribed by a larger proportion of providers, such as the statins. DIPN is more likely to occur in patients with concomitant risk factors such as preexisting neuropathy, diabetes, and associated genetically predisposing diseases. DIPN is often difficult to treat, however medications including duloxetine, and gabapentin are shown to reduce neuropathic pain. Advanced techniques of neuromodulation offer promise though further randomized and controlled studies are needed to confirm efficacy. Conclusion: Awareness of the drugs covered in this review and their potential for adverse neuropathic effect is important for providers caring for patients who report new onset symptoms of pain, paresthesia, or weakness. Prevention of DIPN is especially important because treatment often proves challenging. While many pharmacologic therapies have demonstrated analgesic potential in the pain caused by DIPN, many patients remain refractive to treatment. More studies are needed to elucidate the effectiveness of interventional, neuromodulating therapies.

The Association Between the Incidence Risk of Peripheral Neuropathy and PD-1/PD-L1 Inhibitors in the Treatment for Solid Tumor Patients: A Systematic Review and Meta-Analysis

“…Peripheral neuropathy is a painful condition deriving from many and varied etiologies (38, 39). Certain medications have been implicated in the iatrogenic development of drug induced peripheral neuropathy (DIPN) and include chemotherapeutic agents, antimicrobials, cardiovascular drugs, psychotropic, anticonvulsants, among others (39).…”

Kampo for the Treatment of Pain in Japan: A Review

“…Moreover, neuropathy is one of the most frequent chemotherapy-related complications [17]. Chemotherapy-induced neuropathic pain is highly refractory to drugs such as opioids, tricyclic antidepressants, and anticonvulsants, as is diabetic neuropathic pain [18].…”

Myocardial ischaemia reperfusion injury and cardioprotection in the presence of sensory neuropathy: Therapeutic options

“…Among cardiovascular drugs, the cholesterol‐lowering statins (simvastatin, pravastatin and fluvastatin) seem to have significant risk factors for the development of primary sensory neuropathy (Jones et al, 2019). However, only a few clinical trials or meta‐analysis studies have identified statin‐related peripheral neuropathy, which was predominantly of the sensory type (summarized in the review of Jones et al, 2019), and the mechanism is also largely unknown. It is supposed to be associated with energy depletion of neurons due to decreased ubiquinone synthesis.…”

“…However, their well‐known cardioprotective and anti‐atherosclerotic effects are far outweigh the sporadic appearance of statin‐derived sensory neuropathy. Also, the anti‐arrhythmic drug, amiodarone, in high dose and over a long duration has a risk of causing sensory and motor deficits in patients (Jones et al, 2019).…”