Update on medication-induced peripheral neuropathy

Abstract

Despite improvements in the identification of causes of peripheral neuropathy, idiopathic polyneuropathy remains common. Medication and toxic neuropathy account for a small but important percentage of potentially preventable or reversible causes of neuropathy. New drugs that can induce neuropathy have been approved over the past several years, including the anticancer agents bortezomib, ixabepilone, and oxaliplatin. We review the neurotoxic effects of tumor necrosis factor-alpha blockers infliximab and etanercept, the inflammatory arthritis agent leflunomide, and the antibiotic linezolid. The controversy of statin-induced neuropathy continues to unfold; the large Fremantle Diabetes Study has suggested that statins may have neuroprotective effects. Dichloroacetate is a promising agent for lactic acidosis-associated disorders, but toxic neuropathy is a treatment-limiting factor. We also describe a progressive inflammatory neuropathy in swine slaughterhouse workers that appears to be a toxin-induced immune response.

Simvastatin-Induced Meralgia Paresthetica

“…12 Symptoms have been described as beginning from within days to as long as several years after the prescription of statins. 14 The majority of cases were at least partially reversible with drug cessation. 15 The risk is increased by longer duration of statin use and the cumulative dose.…”

“…4,7,9 Partial or complete recovery after statin cessation has been described. 12,14,15 A case of mononeuropathy multiplex and a case of a disorder resembling GuillainBarré also have been described both after simvastatin use. 16,17 A partial explanation for nerve damage by statins is their inhibition not only of cholesterol synthesis but also of dolichol and ubiquinone; the latter is a key enzyme in the respiratory mitochondrial chain.…”

“…4,6 -9 These results indicate an incidence of peripheral neuropathy attributable to statins of 12 per 100,000 person-years, or a prevalence of 6 per 10,000 persons, 8 or one in 10,000 patients treated for 1 year. 18 The risk is low 14,19,20 ; however, early diagnosis of this reversible neuropathy will reduce patients' suffering and futile diagnostic tests. Conversely, lately, statin use has been negatively associated with new peripheral sensory neuropathy in a longitudinal study of diabetic patients.…”

Drug-induced neuropathies

“…Większość substancji neurotoksycznych powoduje uszkodzenia o charakterze aksonopatii, stosunkowo rzadko obserwuje się neuronopatie czy mielinopatie. W każdym przypadku stwierdzonej mielinopatii należy wykluczyć demielinizacyjne polineuropatie zapalne [4][5][6].…”

“…Opisano pojedyncze przypadki poliradikuloneuropatii oraz neuropatii o charakterze demielinizacyjnym [41][42][43]. Uszkodzenie cienkich włókien powoduje palą-cy lub kłujący ból stóp, często z przeczulicą, parestezjami i allodynią.…”