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Peripheral neuropathy: sometimes medication-related

Numerous medicinal products (especially anticancer and anti-infective drugs) expose patients to damage of the peripheral nerves, resulting in highly debilitating disorders.

Peripheral neuropathy is damage to the peripheral nerves. Depending on the nerves affected, the disorder can be sensory or motor, or can result in damage to the autonomous nervous system (involuntary functions that control the circulation, secretions, excretions, etc.).

Generally, drug-related sensory damage affects the lower limbs, starting with the feet and then progressing upwards, ranging from unpleasant sensations, numbness and pain to the loss of all sensation. Motor damage takes the form of muscle weakness that can worsen and result in the inability to remain standing or to hold objects. The loss of involuntary functions can manifest itself in various ways.

Neuropathies can be severe and debilitating, even life-threatening. There are many possible causes for these disorders including infections, immune or inflammatory disorders, metabolic or endocrine disorders, cancers, hereditary diseases, alcohol, pesticides, and herbicides.

Many anticancer drugs are also implicated: thalidomide, lenalidomide, bortezomib, platinum salts, taxanes, vinca-alkaloids, fludarabine, nelarabine, etc. Other drugs include anti-infective drugs as well as various medications used to treat cardiovascular disease, and prescribed in rheumatology (leflunomide), etc.

Drug-related neuropathies are generally linked to the dosage and duration of treatment. Other contributory causes include drug combinations, diabetes and chronic high-volume alcohol consumption. Their progression is variable, and is generally reversible once the medication is stopped, but their regression is often slow.

©Prescrire 1 September 2013

"Drug-induced peripheral neuropathies" Prescrire Int 2013; 22 (141): 208-212. (Pdf, subscribers only).

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