The Fluoroquinolone Toxicity Research Foundation

 
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Peripheral neuropathy associated with fluoroquinolones.
Lancet. 1992 Jul 11;340(8811):127. No abstract available.
PMID: 1352007; UI: 92310033

Drug Saf 1991 Jul-Aug;6(4):302-14
Prevention and management of drug-induced peripheral neuropathy. Olesen LL, Jensen TS
Department of Neurology, Aalborg Hospital, Denmark.

When symptoms of peripheral neuropathy appear, the possibility that they have been induced by drugs should be considered. A large number of drugs of all kinds, several of which are considered indispensable, have been implicated in peripheral neuropathy. A list of some of these drugs is provided. Neuropathy is a universal and dose-limiting factor during treatment with vinca alkaloids, but is otherwise a rare complication of drug therapy. Drug-induced peripheral neuropathy is almost always due to a dose-dependent primary axonal degeneration caused either by toxic reactions or by metabolic changes in neurons or their surroundings. The use of drugs should be restricted, especially in patients with a risk for development of neuropathy or with already existing neuropathy, e.g. patients with hepatic or renal failure, diabetes mellitus, or malnutrition. Patients should be given vitamins, prophylactically or therapeutically, which will sometimes allow a treatment to be continued. In other cases of drug-induced neuropathy the drug should be stopped. Reversal depends on the severity of the neuropathy, intensity and duration of the treatment and existence of causative cofactors, but generally the prognosis is good. While waiting for recovery physiotherapy is of importance, and when paraesthesia and pain are troublesome the patient should be treated with carbamazepine, imipramine or lidocaine (lignocaine).



J Antimicrob Chemother 1996 Apr;37(4):831-7 Related Articles, Books, LinkOut
Peripheral sensory disturbances related to treatment with fluoroquinolones.

Hedenmalm K, Spigset O
Division of Clinical Pharmacology, Norrland University Hospital, Sweden.

The symptoms and possible risk factors of peripheral sensory disturbances related to fluoroquinolones are reviewed on the basis of 37 reports submitted to the Swedish Adverse Drug Reactions Advisory Committee. In 25 patients (68%), symptoms occurred within 1 week after start of treatment. Paraesthesia was the most common complaint and occurred in 81% of the cases. Fifty-one per cent of the reports concerned numbness/hypoaesthesia, 27% pain/hyperaesthesia and 11% muscle weakness. Seventy-one per cent of the patients recovered within 2 weeks after drug discontinuation. Possible predisposing factors were impaired renal function, diabetes, lymphatic malignancy and treatment with another drug known to cause neuropathy.

Br Med J 1979 Mar 10;1(6164):663-6 Related Articles, Books, Drug-induced peripheral neuropathies.
Argov Z, Mastaglia FL

Review of the various drugs in current clinical use showed that over 50 of them may cause a purely sensory or mixed sensorimotor neuropathy. These include antimicrobials, such as isoniazid, ethambutol, ethionamide, nitrofurantoin, and metronidazole; antineoplastic agents, particularly vinca alkaloids; cardiovascular drugs, such as perhexiline and hydrallazine; hypnotics and psychotropics, notable methaqualone; antirheumatics, such as gold, indomethacin, and chloroquine; anticonvulsants, particularly phenytoin; and other drugs, including disulfiram, calcium carbimide, and dapsone. Patients receiving drug treatment who complain of paraesthesie, pain, muscle cramps, or other abnormal sensations and those without symptoms who are receiving drugs that are known or suspected to be neurotoxic should undergo neurological examination and studies of motor and sensory nerve conduction. This will allow the incidence of drug-induced peripheral neuropathy to be determined more precisely.

J Antimicrob Chemother. 1988 Aug;22(2):221-8. No Authors listed. MILY: Therapy of acute and chronic gram negative osteomyelitis with Ciprofloxacin, Report from a Swedish Study Group
Ten adverse events related to ciprofloxacin treatment were observed in nine patients; two phototoxic reactions, two cases of impaired colour vision, and one each of exanthema, abdominal pain, malaise, drug fever, peripheral neuropathy and eosinophilia.


Chan PC, Cheng IK, Chan MK, Wong WT. Br J Clin Pract. 1990 Dec;44(12):564-7.
Clinical experience with pefloxacin in patients with urinary tract infections. “The incidence of possible side-effects was high, occurring in 59% of the patients. Nausea, dizziness and vomiting were the most common. These were mild and did not require termination of treatment. Peripheral neuropathy, which disappeared four weeks after stopping pefloxacin, occurred in one patient.

Aoun M, Jacquy C, Debusscher L, Bron D, Lehert M, Noel P. Peripheral neuropathy associated with fluoroquinolones (letter). Lancet 1992;340:127

Rollof J, Vinge E. Ann Pharmacother. 1993 Sep;27(9):1058-9 Neurologic adverse effects during concomitant treatment with Ciprofloxacin, NSAIDS and chloriquine, possible drug interaction. “After indomethacin was reintroduced, the patient developed signs and symptoms of peripheral neuropathy, which partially subsided when ciprofloxacin was discontinued.

Zehnder D, Hoigne R, Neftel KA, Sieber R. Painful dysaesthesia with ciprofloxacin. British Medical Journal. 1995 Nov 4;311(7014):1204. “One case of peripheral neuropathy has been reported.3 We report two cases of generalised painful dysaesthesia due to ciprofloxacin, a reaction not previously associated with this particular fluoroquinolone