When you take prescription medications, you want them to help you get better, not make things worse. But some of these drugs can cause a serious side effect called peripheral neuropathy. This happens when there is damage to your peripheral nervous system. The peripheral nervous system is important because it carries messages between your brain, spinal cord, and the rest of your body. If there is damage, this connection does not work well. Knowing how some drugs can cause this problem is the first step to spotting the signs and speaking up for your health. Do you know about the risks that come with your current medications?
Peripheral neuropathy is not just about feeling uncomfortable. It is a problem with your peripheral nervous system. This system links your central nervous system to muscles, skin, and internal organs. When nerves there get damaged, you may have pain, be weak, or lose feeling. These issues can really lower your quality of life.
It is important to notice the symptoms of peripheral neuropathy early. Watch out for tingling, numbness, burning pain, or weakness. These symptoms may show up in your hands or feet first. They could mean your body is telling you that a medicine is hurting your nerves. Below, we talk about this condition and its symptoms more.
Peripheral neuropathy happens when one or more of the peripheral nerves are damaged. The peripheral nerves are found outside the brain and spinal cord. They make up a large network known as the peripheral nervous system. If these nerves have been damaged, they may not send signals the right way.
When there is nerve damage, it may affect the axon. This part of the nerve cell works to send out signals. Nerve damage can also harm the myelin sheath. The myelin sheath is the layer that covers the axon and helps messages move fast and smoothly. Both kinds of damage stop normal feeling and body movement.
Most of the time, peripheral neuropathy shows up as a polyneuropathy. That means many nerves get hurt. This usually causes tingling or a numb feeling in the feet or hands first. The trouble can then move closer to the middle of the body. Knowing about this nerve damage early in the process can help you look for help and notice symptoms.
Peripheral neuropathy is not just one problem. It can be sorted by the kind of nerves that are affected. Each kind brings its own symptoms. These can help people and doctors know what the problem is.
The main types of neuropathy are:
Often, with drug-caused neuropathy, people get more than one type of these at once. This puts you at a higher risk of polyneuropathy. You may have both sensory neuropathy and motor neuropathy, so you get muscle weakness and other symptoms. This can really make daily life harder.
The number of people with peripheral neuropathy in the United States is high. This health problem is common in the country. Many people have it for reasons that are not known. Still, about 24% of all cases of peripheral neuropathy happen because of drugs or toxins. That means a lot of people get this after taking certain medicines or being exposed to harmful stuff. It is a big issue with many health treatments.
For those who have peripheral neuropathy, the side effects can really change their quality of life. Chronic pain, sensory deficits, and muscle weakness can make it hard to do everyday things. This can keep people from working, enjoying time with friends, or being active. The problem can raise the chance of falls, which is especially dangerous for older adults. Over time, people can have serious pain or lose feeling, which may keep them from doing what they need to do.
In places like the United States, chemotherapy often causes drug-induced neuropathy. As more people survive cancer and live for many years after, the side effects like peripheral neuropathy are also increasing. That means it is very important now to find ways to prevent and take care of this problem well.
Prescription drugs can lead to peripheral neuropathy by harming your nerves in different ways. The damage happens when a drug changes how your nerve cells work or affects what keeps them running. This can mess up the signals that nerves send. It is one major cause of peripheral neuropathy that does not come from another illness.
Many types of medication, like those used in chemotherapy and some antibiotics, can be the reason for nerve damage. How these drugs hurt the nerves is not always the same. Knowing this helps people see why some are more likely to get nerve damage than others. In this article, we will look at how these drugs work, what risk factors there are, and how doctors find out if someone has this condition.
The ways that drugs cause nerve damage can be hard to understand, but most fit into a few main types. The toxic effect of a drug can directly hurt the peripheral nerves, which are the nerves outside the central nervous system.
One common cause is axonal degeneration. This is when a drug harms the axon. The axon is the long part of a nerve cell that sends signals. If the axon is hurt, it cannot send messages as it should, and this often leads to numbness and weakness. Drugs can also damage the myelin sheath. This covering protects the axon and helps the signals move fast.
Different drugs may go after different parts of the nerve. Here are some common ways nerve damage can show up:
Not everyone who takes a drug that can be bad for the nerves will get peripheral neuropathy. Some risk factors can make you more likely to have this problem. Knowing these can help you and your doctor choose the best way to handle your care.
The amount you take and how long you use the medication are big risk factors. Taking medicine for a long time, or having a high dose, raises your chance of nerve damage. With chemotherapy drugs, the danger gets bigger as time goes on because the toxic effects build up.
Other things that can make your risk go up include:
Some groups of people are more likely to get medication-induced peripheral neuropathy. These people may have health problems or risk factors that make their nerves get hurt from drugs more easily.
Older adults are one group at higher risk. As people grow older, their nerve function changes. Seniors are often on more than one medicine at a time. This makes it more likely for them to have issues related to nerve damage from those drugs. Their bodies can also handle medications in a different way, so even normal doses might be too strong for them.
People with diabetes also have a higher risk of nerve problems. Their blood sugar can hurt nerves as time goes on, leading to diabetic neuropathy. If they take medicine that can cause nerve damage, it might make their symptoms worse or start new problems. Cancer patients are another group. Many drugs used to treat cancer, called chemotherapeutic agents, often cause nerve damage while treating the illness.
So, risk factors like being an older adult or having diabetes make a person more likely to get peripheral neuropathy or nerve damage from such drugs. Many cancer patients are affected as well when taking medicine for their recovery.
Many prescription medicines have been known to cause peripheral neuropathy. Chemotherapy drugs might be what people think of first, but they are not the only ones. Medicines that fight infections, help with heart problems, or treat autoimmune diseases can lead to this, too.
It helps to know which types of prescription drugs may cause side effects like peripheral neuropathy. This way, you can look out for any symptoms, talk about them with your healthcare provider, and stay on top of your health. Antibiotics and some drugs that treat heart issues are examples. Next, we will take a closer look at these drug groups.
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common and dose-limiting side effects for cancer patients. Many life-saving chemotherapeutic agents can cause significant neuropathic pain and sensory loss, affecting a patient's quality of life during and after treatment, especially for conditions like breast cancer.
The incidence of CIPN is high. A systematic review found that 68% of patients experience neuropathy within the first month of treatment. While this number can decrease over time, up to 30% of patients still report symptoms six months after finishing therapy. This highlights the need for better prevention and support care in cancer treatment.
Certain chemotherapy drugs are more likely to cause this condition. The table below shows the incidence of neuropathy associated with some common agents.
Some drugs that are used for the heart and blood pressure have side effects. One of these side effects can be peripheral neuropathy, but not everyone knows this. If you take medicine for your heart or blood pressure, it is good to know about the risk of polyneuropathy.
One drug called Amiodarone helps people who have a heartbeat that is not normal. Studies show that about 6 out of 100 people who take it may get neuropathy. Another drug is Hydralazine, which people use to help with high blood pressure. Both of these medications may hurt the peripheral nerves over time, and this can bring on symptoms later.
Many people with heart and blood pressure problems use these drugs for years. Because of this, their risk of polyneuropathy can go up. If you take these pills and start to notice strange tingling, numbness, or weakness, you need to tell your doctor. They know what to look for and can help figure out if your medicine is the cause.
Some antibiotics that doctors give to treat infections can cause nerve damage. Not every antibiotic has this side effect, but some classes of these drugs do. This is important because nerve problems can be really serious.
Some antibiotics are known to be linked with peripheral neuropathy. These drugs include Metronidazole (Flagyl), Nitrofurantoin, and fluoroquinolones. Another one is Isoniazid, a medicine doctors use for tuberculosis. These medicines can hurt the nerves in your body in a direct way. When this happens, people can get neuropathic symptoms.
There are risk factors that make nerve damage from antibiotics more likely. Some of the common ones are how large the dose is and how long you take the medicine. Clinical trials help us understand these side effects more, but it is important for people to know about the risk factors. If you notice new nerve side effects, you should talk to your healthcare provider.
Some medications used to work on the immune system, like antiretrovirals for HIV/AIDS and immunosuppressants for certain diseases, can lead to the development of neuropathy. These drugs are very important to treat and manage serious health problems. But sometimes, they harm the peripheral nerves in the body.
Antiretroviral drugs such as Stavudine and Didanosine have been linked to a high risk of peripheral neuropathy. For example, Zalcitabine and Stavudine are known to cause this problem in about 10% of people who use them. This is most likely because these medicines have toxic effects on nerve cells.
Some immunosuppressants, such as TNF-alpha inhibitors (like Infliximab and Etanercept) and Tacrolimus, are used with autoimmune conditions such as rheumatoid arthritis. These, too, can cause peripheral neuropathy. This may happen when the drug affects the immune system in a way that makes it attack the peripheral nerves by mistake.
Besides the main types we talked about, other kinds of prescription drugs have been linked to peripheral neuropathy. You should know about these side effects from medications because they can happen with drugs that many people get from their doctors. Official government organization websites like MedlinePlus have lists of these medicines.
For example, some drugs used for seizures, like Phenytoin and Carbamazepine, can cause nerve damage if you use them for a long time. Phenytoin is known to cause peripheral neuropathy in about 18% of people, mostly when the amount in the body is high. This might seem strange because some of these same drugs also help with neuropathic pain.
Other medicines that may cause nerve damage are:
If you take too much pyridoxine (Vitamin B6), it can also give you nerve damage.
If you are taking a medication that is known to cause nerve damage, you need to watch for signs early. Being aware of the symptoms of peripheral neuropathy is your best way to stop things from getting worse. At first, these symptoms can be small or hard to see. They can get worse if you do not do something about the cause. Most of the time, these signs are divided into sensory, motor, and autonomic changes.
Knowing these different kinds of symptoms can help you tell your doctor what is going on. Do you have any odd feelings, new weakness, or any problems with things your body does by itself? Watching out for pain symptoms and other signals is important. Let's look at each group of symptoms of peripheral neuropathy to learn more.
Sensory changes are often the first and most common signs of peripheral neuropathy caused by medication. The nerves that help you feel touch, pain, and temperature are being damaged. This is why these problems show up.
At first, you might feel tingling, or like you have "pins and needles," in the hands or feet. Then, this can turn into numbness. You may not be able to feel things as well as you used to, or you may lose feeling in those areas completely. You can also get burning pain. This pain might be mild at first, or it could get worse, and this can be very hard to deal with.
Sensory deficits can be dangerous. If you lose sensation in your feet, you might not notice small cuts or blisters. These could turn into bigger problems, like infections. If you can’t feel hot or cold, you could get burned without knowing it. It’s important to pay attention to these changes so you can get help if you need it.
When motor neuropathy happens, the nerves that help move your muscles can be damaged. This can give you different signs that include problems with movement and strength.
The main sign is muscle weakness. You could have trouble holding things. Sometimes, you see "foot drop." This means you cannot lift the front part of your foot, so you drag your toes while you go walking. Weakness often starts in your hands and feet first. Then, it can spread up your arms and legs.
This muscle weakness may cause a loss of balance and poor coordination. You could feel unsteady while on your feet. Because of this, falling can be more likely. If you get clumsier or have trouble with jobs that need good fine motor skills, then motor neuropathy or nerve damage might be causing this.
Autonomic neuropathy does not happen as often as other nerve problems, but it can be very serious. This condition happens when the nerves that control things your body does automatically, like heart rate, digestion, and blood pressure, get damaged.
The symptoms can be very different from person to person because they depend on which nerves are hurt. You may sweat a lot more or a lot less. This can make it hard for your body to keep its temperature steady. You might also feel dizzy or even faint when you stand up fast. This is called orthostatic hypotension, and it happens because your blood pressure drops quickly.
Some other signs to watch for are stomach troubles, trouble peeing, or an irregular heartbeat. Because these problems could be from many other health issues as well, it is a good idea to talk to your doctor. They can help figure out if what you feel is from autonomic neuropathy or something else.
If you and your doctor think that your medicine might be causing peripheral neuropathy, the next step is to find out for sure. It is important to confirm nerve damage and check that other things, like diabetes or vitamin deficiencies, are not the cause of your symptoms.
Usually, this process involves a talk about your health, a physical check, and some tests. These lab tests help your healthcare provider figure out how bad the nerve damage is and what kind it may be. The next parts will talk about each step in this testing process.
The first step to finding out if a medicine is causing your neuropathy is a full checkup with your healthcare provider. Your healthcare provider will start by taking a detailed patient history. This is very important for making a good diagnosis.
You will need to talk about the symptoms you have. This includes when the symptoms started and how they have changed over time. You should be ready to talk about the feelings you notice. Say if the pain feels like burning, stabbing, or tingling. You also have to give a complete list of all the medicines you take. This means prescription drugs, over-the-counter medicine, and any vitamins or supplements.
The time your symptoms started, and if that matches when you took a new medicine, is important. Your healthcare provider will do a systematic review of your medicine list to look for drugs that can cause neuropathy. This history helps the healthcare provider see if there might be a link between the medicine and the symptoms you are feeling.
After asking about your health history, your doctor will do a full check-up of your body and nerves. This exam is done by hand to see how much nerve damage you have.
During the nerve check, your reflexes, muscle strength, and muscle tightness will be tested. Your doctor will tap on your ankles and knees to see if your tendon reflexes are normal, weaker, or gone. This is because, when people have nerve damage or neuropathy, these reflexes often do not work very well. Your doctor will also watch how you balance or walk and may have you do some movements. This shows how well you move and if you have good balance.
For sensory neuropathy, your doctor will test if you can feel different things. The doctor may use a light tool called a monofilament to touch your skin and check your sense of touch. They may use a tuning fork to test if you feel vibrations. Cold and warm objects might be used to see if you notice temperature changes. What they find in this exam will help them know which nerve fibers are not working well. These results may help decide if you would benefit from physical therapy.
To make sure you have peripheral neuropathy and to rule out other problems, your doctor may ask you to do a few tests. These tests show clear signs of nerve damage. They also help the doctor see what type you have and how bad it is.
Blood tests are often done to find other reasons for nerve problems. Your doctor checks for things like vitamin deficiencies, such as low B1, B6, or B12. You may also be tested for diabetes or kidney issues. These blood tests are very important. They help show if there is another reason for the development of peripheral neuropathy besides nerve damage.
There are more specific tests used to look at how your nerves work:
The time it takes for neuropathy to show up from medicine can be very different for each person. The start of symptoms depends on the drug you take, how much you use, and your own risk factors. Some people may see signs right away, while others need to take the medicine for a longer time before anything happens.
It is good to know that the timeline can change from person to person. For some, the duration of treatment is the biggest factor. They do not get signs until months or years later. For others, symptoms can start almost at once. Below, we talk about when symptoms might begin, how they can change over time, and the risk factors that can affect the development of neuropathy.
The time when symptoms start after you begin a new medication can be hard to know. The symptoms may show up right away, or they might take weeks or even months to appear after you stop treatment.
For example, some drugs, such as the chemotherapy drug paclitaxel, can lead to tingling in the fingers and toes as soon as 24 hours after you get the medicine. This happens because the drug has a fast effect on nerve signals in your body.
But other medications work more slowly. For instance, the chemotherapy drug cisplatin usually causes the first signs of nerve problems about one month after you start treatment. Sometimes, nerve problems, or neuropathy, start or get worse even after you stop taking the medication. This makes it hard to notice that the symptoms or changes come from the drug.
Once you start to notice symptoms, how they get worse can be different for each person. For many people, if the neuropathy is caused by a drug, the symptoms will get worse if you keep taking that drug. As time goes by, you may end up with ongoing issues that make daily life hard.
Sometimes, neuropathy may stop getting worse and then slowly get better after you stop the medicine. This can happen with drugs like paclitaxel. But it is not the same for every drug. For example, with oxaliplatin, which is another chemotherapy drug, the nerve symptoms can keep getting worse for up to three months after you stop the treatment.
The changes can include losing more feeling, feeling more pain, or having weaker muscles. When small fiber neuropathy happens, it can cause a burning pain that does not go away easily. This pain can stay with you and be hard to treat, even after you stop taking the pain medicine.
Several things can affect how fast medication-induced neuropathy appears. These risk factors can make your nerves weaker and cause nerve damage to happen sooner.
Your overall health is important in the development of neuropathy. If you already have problems that hurt your nerves, you may get drug-induced neuropathy quickly. People who have diabetes mellitus are at higher risk, as they may already have nerve damage.
Other things that can increase the risk for the development of neuropathy include:
While you may not be able to stop peripheral neuropathy all the time when you need to take important prescription drugs, there are things you can do to bring your risk down. Prevention is about keeping a close eye on your health, watching risk factors, and talking with your doctors often.
The main thing is to find a way for your medicine to work well for you without causing too much nerve damage. Being active and careful can help keep your nerves in good shape. Here are some top ways to help with prevention.
One of the most important things you can do is to have a careful talk about your medications and a risk check with your healthcare provider. It’s best to do this before starting any new treatment that might bring the risk of neuropathy.
Your provider will take a good look at your medical history and how you are feeling now. They will check for risk factors like diabetes or if you have had any neuropathy before. They will also think about the medicine, how much of it you will take, and how long you will use it. This helps them know your personal risk for side effects. By doing this early, you get a safer and better treatment plan.
During these talks, you should:
Working together with your healthcare provider means you get to help make the choices about your care.
Making simple changes in your daily life can help protect your nerves and lower your chances of getting nerve damage from medicines. These changes can help your overall health and make your nerves stronger.
If you have diabetes, it is very important to keep your blood sugar under control. High blood sugar often leads to nerve damage. If you keep your blood sugar in a healthy range, it can take stress off your nerves. Try to cut down or skip alcohol because it is bad for your nerves.
Other good changes you can make:
Open and regular talks with your healthcare provider are key to stopping and handling medication-induced neuropathy. You know best how you feel, so it is important that you speak up about any new or changing symptoms.
Never wait to tell someone, even if you feel mild tingling or numbness. If your doctor spots signs early, they can act fast. This could mean lowering the dose, trying another medicine, or starting other steps to help you feel better. Do not wait until it gets bad.
Your healthcare team is there for you. This team can include your doctor, the nurses, and the pharmacists. You may also use information from places like an official government organization to learn about your condition. Keep in mind, good communication with your team is a two-way street. It can help you get better results for your health.
If you get peripheral neuropathy because of a medication, there are ways to help and treat it. The main goals are to stop more nerve damage, help with neuropathic pain, and improve your quality of life.
Treatment will be matched to your symptoms and how bad they are. It might be as simple as changing your medication, or it could involve other steps to manage pain and help you move better. Now, let’s look at the different ways you can deal with this condition.
The first thing you need to do for medication-induced neuropathy is to find and fix what is causing it. Most times, you have to stop taking the drug that causes the nerve damage, lower how much you take, or use another medicine that does not have the same risk.
You must not stop any medicine or change how you use it by yourself. Talk to your healthcare provider first. Your healthcare provider will help you stop the drug safely and check if other treatments will work with your health needs. Many times, when you stop taking the drug, it can stop the nerve damage from getting worse.
Some people see a lot of improvement after making this change. The nerves may start to heal, and pain or other signs may go away bit by bit. But for some, symptoms stay even after stopping the drug, so they need more help for the pain and discomfort.
When neuropathy symptoms stay for a long time, the main goal of treatment is to help you feel better and manage the ongoing neuropathic pain. There are no medicines that can undo the nerve damage. But there are many that can help with the pain.
Your doctor may give you some medicine to help with nerve pain that feels like stabbing or burning. These drugs work by making the nerve signals less busy. You might try pain relievers you get at the store for mild pain, but they usually do not help much with bad nerve pain.
Common medicines your doctor may use include:
Physical therapy helps people who have peripheral neuropathy. It is the best way to manage problems like muscle weakness and loss of balance. A physical therapist will work with you to make you stronger, help you move better, and help you be steadier on your feet. This can also help you stay safe when you walk or stand, and make it easier for you to do things on your own.
If the muscle weakness or loss of balance is causing problems, you can talk to the therapist about it. The therapist will plan exercises that fit your needs. These exercises help you use and build up your muscles. This extra strength can help with walking and keep you from falling. Training to hold your balance is a big part of getting better for people with muscle problems.
The therapist may suggest some things that you can use to move or stand more safely. You may get an ankle-foot device to help the foot move correctly. Some people use canes or walkers to keep from tipping over. If feet have trouble feeling, a physical therapist can point out good shoes that keep your feet safe.
Let the therapist guide you if you have peripheral neuropathy, muscle weakness, or trouble balancing. With physical therapy help, you can get better and stay safe.
Along with regular treatments, some people find help from other kinds of therapy. These can be used with standard medical care to help manage symptoms and make you feel better, especially for cancer patients who need supportive care. Some emerging treatments, like Nupera’s 2-step approach, offer additional support in managing neuropathy. This combination of NuperaPULSE and NuperaWave helps stimulate blood flow and promotes the regeneration of peripheral nerves, offering a non-invasive option to complement traditional therapies.
There is some early evidence that shows certain supplements, such as alpha-lipoic acid, might help lower symptoms of diabetic neuropathy. But you need to talk to your doctor before you start taking any new supplement. It is important because these can react with other medicines you might be taking. This is a big part of using alternative medicine in a safe way.
Other ways that people try or that are being studied include:
It is important for caregivers, patients, and healthcare professionals to know how prescription medications can cause peripheral neuropathy. People should learn about the risks that come with different drugs. This helps them watch for symptoms, talk clearly with doctors, and choose the best way to treat the problem. You can manage the effects of medication-induced neuropathy through lifestyle changes or other types of therapies. There are many options to help with this. The first thing you need for better health is to have good information. If you think your medicine is giving you peripheral neuropathy, or if you want to know about other treatments, talk to a healthcare professional. They can help you figure out what to do.
Drug-induced peripheral neuropathy may not go away completely, and there might be no full cure. Still, if you stop taking the medicine that causes it, you can often get better in part or even fully. The main goal is to help manage the symptoms. Treatment aims to ease pain and help you feel better in your daily life. This helps improve your quality of life.
If you think your medicine may be giving you neuropathy, get in touch with your healthcare provider right away. Do not stop taking it by yourself. The healthcare provider will know what to do. They can find out what is going on and decide the best way to help you.
A neurologist is the main doctor who finds and treats neuropathy. Your regular healthcare professional can help take care of you. You might also get help from a physical therapist if you have trouble moving. A pain management specialist may help with pain.
SOURCES:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy
https://medlineplus.gov/ency/article/000700.htm
https://www.nhs.uk/conditions/peripheral-neuropathy/causes/
https://www.prosperabiotech.com/en/blog/drugs-cause-peripheral-neuropathy
https://www.aafp.org/pubs/afp/issues/2020/1215/p732.html
https://www.health.harvard.edu/diseases-and-conditions/peripheral-neuropathy-causes-symptoms-treatment-and-prevention
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