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Neuropathy from Chemotherapy
Zoe Ngo, PharmD
University of California San Francisco- MtZion Cancer Center

Neuropathy from Chemotherapy Introduction
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Chemotherapy can have adverse effects on the nervous system. Some chemotherapy such as vincristine, cisplatin, and paclitaxel have been known to cause symptoms of neuropathy such as numbness, tingling and pain in the extremities, mild weakness, and constipation. Severe nerve damage may cause impaired walking abilities, severe bladder dysfunction, and disabling sensory loss. These side effects may improve or disappear after the discontinuation of chemotherapy, but may take several months to do so.

Several medications can be given to alleviate these symptoms and are listed below. Often times, they are combined with analgesics or narcotic medications to provide maximum pain relief. Response to therapy varies with each individual and their tolerance to possible side effects. Many of these medications are used to treat other health conditions and not all medications may be appropriate for you. Speak to your physician about your treatment options.

Non-medicinal methods can also be used to help manage neuropathy. If your fingers are numb, be very careful when grasping sharp, hot, or otherwise dangerous objects. If your sense of balance or muscle strength is affected, avoid falls by moving carefully, using handrails when going up or down stairs, and using bath mats in the bathtub or shower. And always wear shoes with rubber soles (if possible) to protect your feet.

Medications Table
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Drug Drug Class Usual Dose Adverse effects
Amitriptyline Desipramine
Antidepressants 10-150mg a day
10-150mg a day
50-300mg a day
10-60mg a day
10-100mg a day
18.75mg- 37.5mg once or twice daily
Constipation, dry mouth, blurred vision, cognitive changes, rapid heart rate, urinary retention
Anticonvulsants 100mg-400mg three times a day
500mg-1000mg three times a day
100mg-1000mg three times a day
0.5mg- 4mg twice a day
Nystagmus, dizziness, diplopia, cognitive changes, somnolence, fatigue, mood and sleep disturbance
Local Anesthetics 100mg twice a day to 300mg three times a day Nausea, stomach upset, dizziness
Baclofen Miscellaneous 5mg-20mg three times a day Sedation, dizziness, ataxia, confusion, N/V
Clonidine Miscellaneous 0.3mg-1mg twice a day; max 2.4mg/day Dry mouth, dizziness, sedation, constipation, low blood pressure
Glutamine Miscellaneous 10mg three times a day for 4 days starting 24 hours after chemotherapy No significant adverse effects reported
Capsaicin Miscellaneous Apply topically to affected area 3 to 4 times a day Burning (lessens with repeated use), stinging; redness
Tramadol Miscellaneous 50mg to 100mg every 4 to 6 hours, not to exceed 400mg/day Dizziness, headache, sedation, nausea, constipation
Pyridoxine (vitamin B6) Miscellaneous 50-300mg daily Nausea, headache

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