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Written by Louis H. Weimer, MD, Clinical Professor of Neurology, Co-director Columbia
Neuropathy Research Center, Columbia University Medical Center
This fact sheet is intended to alert patients with Charcot-Marie-Tooth about medications that
might worsen their neuropathy and be harmful to their strength, sensation, and function. Of the
thousands of recognized medications, only a small number are known to damage ner ves or cause
neuropathy. Most of these drugs fall into two broad categories: chemotherapies or antibiotics,
but numerous other treatments are also known to cause ner ve injur y. While there are notable
exceptions, most examples of toxic neuropathy produce damage to sensation or pain ner ves and
have lesser effects on motor or strength ner ves.
The nerves of individuals with neuropathy from any
long the agent stays in the body. For example, the heart
cause, including CMT, may be more vulnerable to certain
drug amiodarone may take several months to clear
conditions and stresses such as toxins and certain medi-
one’s system. Alternatively, some medications may carry
cations than other people’s nerve. The list of potentially
excessive concern only because they are used so widely,
toxic medications can be divided by the relative likeli-
such as statins and certain stomach acid blockers. The
hood or risk of causing a problem. Some medications
decision to stop a treatment to see if improvement occurs
are well known to cause toxicity, while others have been
must be weighed against the benefits of treatment.
found to cause neuropathy only rarely. For a handful of
medications, evidence of toxicity is controversial, doubt-
For most drugs listed, the risk of exposure must be
weighed against the benefit of use, including the severity
of the treated condition, available alternative treat-
Other factors may further influence whether a treatment
ments, and drug effectiveness. There is only one example
is tolerated or not, including other medical conditions,
of a treatment that must be avoided in all circumstances.
especially diabetes, kidney failure, or alcohol abuse.
This exception is the chemotherapy treatment vincristine
Establishing a clear causative link between medication
that may cause severe weakness and nerve injury after
use and increased symptoms or nerve loss is not always
only 1 or 2 doses in patients with minimal or unknown
simple. Worsening nerve function very soon after starting
CMT1A, the most common form. This medication carries
a new drug is very suspicious, especially if the medication
a “black box” warning by the Food and Drug Administra-
is of high concern. However, some agents may cause
tion (FDA) against use in CMT patients or in patients that
problems only after extended use, for example the antibi-
might have CMT (e.g., relatives of individuals with CMT).
otics metronidazole and linezolid. Toxicity of this type after
Virtually all other treatments carry a relative but not abso-
lute risk of use. There is no proven link between worsening
neuropathy and anesthesia or vaccinations, although
When problems appear immediately after starting a
some claim increased symptoms following these events.
new treatment or medication, it is important to see your
In most but not all instances the condition prevented by
doctor as soon as possible. One would expect symptoms
a vaccination is much worse than the consequences of
or function to improve after the drug is stopped;
the injection. It is important, however, to always discuss
however, improvement may be delayed by weeks or
any known family history of CMT with your health care
months depending on the degree of injury and how
provider, particularly your anesthesiologist.
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