Advances in understanding drug-induced neuropathies

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Drug Saf. 2006;29(1):23-30.

Advances in understanding drug-induced neuropathies.

Peltier AC, JW.

Department of Neurology, University of Michigan, Ann Arbor, Michigan,

USA.

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neuropathy improves when the medication is withdrawn.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 HIV-induced neuropathy.

Understanding the mechanism of drug-induced neuropathy has led to

advances in preventing this disabling condition.