Peripheral Neuropathy Associated With Fluoroquinolones

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Peripheral Neuropathy Associated With Fluoroquinolones

Cohen JS

ls of Pharmacotherapy. 2001;35(12):1540-1547

A recent study suggested that fluoroquinolones (such as ciprofloxacin) may

be related to a demyelinating peripheral neuropathy. Cohen reported 39 cases

that appeared to be temporally associated and perhaps causally related to

administration of fluoroquinolones.

The central nervous system adverse effects of fluoroquinolones (eg,

dizziness, headache, seizures, psychosis) have been long recognized and

reported to occur in 1% to 7% of treated patients.[1] However,

fluoroquinolone-associated demyelinating peripheral neuropathies have not

previously been appreciated or listed in the drug-prescribing information.

The report by Cohen of peripheral neuropathy in a larger number of patients

extends previous case reports of demyelinating peripheral neuropathy in

studies involving smaller numbers of patients.[2,3]

Such neuropathies and tendinopathies have been noted in animals treated with

fluoroquinolones.[1,2,4-7] The mechanism proposed for the neurotoxicity of

fluoroquinolones is the inhibition of GABA receptors and/or adenosine

receptors.[1] However, it must be cautioned that the number of patients

reported is small, there was no control group studied for comparison, and

the underlying infection (ie, the condition requiring fluoroquinolone

treatment) may have led to postinfectious demyelination syndrome (ie,

Guillain-Barré).[8]

Thus, in a time when fluoroquinolones are increasingly used by patients and

physicians for prophylaxis and treatment of anthrax, the clinician must

tentatively consider drug adverse effects on the peripheral nervous system

in the differential diagnosis. Also, a potentially important drug

interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and

fluoroquinolones may occur at both the level of GABA receptors and drug

excretion pathways.[9] This was illustrated in a case where coadministration

of the 2 drugs led to a severe neuropathy, and symptoms reversed when the

NSAID was discontinued. Also, fluoroquinolones have been rarely associated

with tendinitis,[10] which is most often bilateral and reverses when the

drug is discontinued.