Medications associated with peripheral neuropathy
| Drug/class | Typical pattern of neuropathy | Notes/additional features |
| Immunosuppressants | ||
| Tumour necrosis factor inhibitors | Acute or subacute polyradiculoneuropathy (axonal or demyelinating) | Some of the conditions being treated with these drugs are also associated with a neuropathy |
| Calcineurin inhibitors (tacrolimus, ciclosporin) | Acute or subacute polyradiculoneuropathy (axonal or demyelinating) | Almost exclusively reported in post-transplant patients |
| Interferon-alpha | Acute, subacute or chronic demyelinating polyradiculoneuropathy | Initial course of immunomodulation usually needed; however, most recover after single course |
| Leflunomide | Length-dependent sensory or sensorimotor axonal | |
| Antibiotics | ||
| Linezolid | Painful predominantly sensory axonal | Dose dependent—mainly with prolonged courses. May also cause optic neuropathy |
| Metronidazole | Painful length-dependent sensory axonal | Dose dependent—mainly with prolonged courses (≥4 weeks). May coexist with ataxia or encephalopathy |
| Nitrofurantoin | Length-dependent sensorimotor axonal, often rapid onset with clinical weakness | |
| Dapsone | Motor-predominant axonal | Dose dependent—mainly with prolonged courses |
| Fluoroquinolones (eg, ciprofloxacin, norfloxacin) | Sensory symptoms, however, detailed clinical features not well documented | Likely to be extremely rare with short courses |
| Antituberculous drugs | ||
| Isoniazid | Sensory predominant axonal | Prevented with pyridoxine (B6) supplementation. Occasionally causes optic neuropathy |
| Ethambutol | Sensory predominant axonal (uncommon) | Optic neuropathy |
| Antifungals | ||
| Some triazoles (itraconazole, voriconazole, posaconazole) | Sensory predominant axonal | May also increase risk of neuropathy with vinca alkaloids and calcineurin inhibitors due to CYP3A4 inhibition |
| Antiretrovirals | ||
| Some nucleoside reverse transcriptase inhibitors (stavudine, didanosine, zalcitabine) | Sensory predominant axonal | Have largely been superseded by non-neurotoxic agents |
| Cardiac drugs | ||
| Amiodarone | Distal predominant sensorimotor, often with both sensory ataxia and distal weakness. Nerve conduction studies may show demyelinating or axonal changes. | Tremor, cerebellar ataxia, optic neuropathy, myopathy may develop |
| Perhexiline | Severe, demyelinating polyradiculoneuropathy | Very common. No longer available in the UK |
| Other drugs | ||
| Phenytoin | Mild axonal or demyelinating sensory or sensorimotor. Commonly asymptomatic signs or nerve conduction abnormalities | Occasional cases of more significant neuropathy associated with high doses/phenytoin concentrations, often without cerebellar signs. Folate supplementation should be given |
| Levodopa–carbidopa intestinal gel | Sensory predominant axonal neuropathy | Due to impaired absorption/metabolism of pyridoxine and other B vitamins |
| Colchicine | Mild sensory predominant axonal | Myopathy usually more prominent |
| Chloroquine | Mild sensory predominant axonal | Myopathy usually more prominent |
| Disulfiram | Sensorimotor axonal, often with clinical muscle weakness | |
| Nitrous oxide | Usually length-dependent sensorimotor. Can also cause a pure motor/motor-predominant neuropathy | Myelopathy often more prominent |
| Pyridoxine (vitamin B6) | Sensory ganglionopathy with prominent large fibre loss and ataxia | Pyridoxine deficiency can also lead to a sensory predominant neuropathy. Mild elevation in plasma concentration (2–3 times upper limit of normal) common with multivitamin supplementation |