Medication Induced Neuropathy

Medication Induced Neuropathy

You’ve undoubtedly heard the old saying, “It’s what you don’t know that can hurt you.” When it comes to Medication Induced Neuropathy, there may be something your doctors don’t know that can hurt you as well.

Renowned New York Times health columnist Jane Brody recently shared with readers of her column that she experienced a bout of peripheral neuropathy several decades ago when a misplaced shot of morphine damaged a sensory nerve in her thigh. Obviously, her doctor never intended for that to happen. Fortunately, the nerve recovered in three years, but for much of that time, Brody couldn’t even tolerate something brushing against her leg.¹ Brody’s peripheral neuropathy can be categorized as an “iatrogenic” case—that is, a condition that is actually caused by medical care.

Iatrogenic causes for peripheral neuropathy aren’t always as blatant as a misplaced shot. In fact, peripheral neuropathy can be caused by nerve toxicity from commonly prescribed drugs: medications prescribed by physicians who are not aware of the possible relationship between the medication and the neuropathy. Why aren’t they aware? After all, aren’t these the experts you trust with your health, your well-being…your life?

Your doctors are well aware of the medications they are prescribing, but the fact is they may not be aware of medications other physicians have prescribed, nor are they aware of every uncommon adverse reaction of a medication. Many medications have hundreds of reported side effects. Often primary care physicians are inundated by a waiting room full of very ill patients requiring immediate care and don’t have time to fully review in detail every note or test result they receive.

Simply put, your specialists and primary physicians need your help. If you have a neuropathy and are concerned it may arise from a medication, speak up. Some medications and interactions between drugs can cause complications and even irreversible conditions. For example, thalidomide has proven to be very effective for treating skin diseases and some kinds of cancer. In fact, thalidomide has experienced a resurgence of use in the medical community for its effectiveness against several dermatological conditions. The occurrence of neuropathy, however, has also been tied to thalidomide. It is not typically related to the daily dose of the drug nor the duration of treatment; it’s more commonly found in patients who are slow drug acetylators—in other words, those patients whose bodies take longer to metabolize certain drugs.

The good news is that when patients with neuropathy stop using thalidomide, 25 percent of them recover completely, and 30 percent improve partially. What’s not so comforting is the fact that 45 percent of reported cases do not recover at all.² This example illustrates the need for you to consult with your physician if you take any of the medications associated with causing neuropathy. It is important to remember that you are not expected to be a medical expert, however, you are expected to know the names of the medications you’re taking, how long you have been taking them, and to be able to describe them to every doctor you visit. Thus, you need to assume the role of being your own patient advocate. Today’s health care system is complicated, and as such, you need to be able to provide to your doctor and to other health care providers as much information about your treatments as possible. Communication of your medications and duration of use is critical for your primary care and specialist physicians to offer you excellence in care.

Take the first step by reviewing the list of medications below that can induce neuropathy and let your physicians know if you are taking any of them. Remember to tell your physicians that you are not questioning their judgment; just asking them to review the medications in the context of your neuropathy. More often than not, they will welcome this active role in your treatment and see this as an opportunity to better educate themselves. Not only will you be helping yourself, but you could be helping others as well. Also, keep in mind that these medication do not always cause neuropathy, and it is the unique metabolism of certain patients that may cause them to develop neuropathy when prescribed a certain drug.

The following is a list of drugs that can cause neuropathy in certain patients:

Danosine (ddl)
Etoposide (VP-16)
Nitrous Oxide
Stavudine (d4T)
TNF-alpha antagonists
Tumor Necrosis Factor
Zalcitabine (ddC)

The peripheral nerves are protected by a blood-nerve barrier and might be perceived to be at a lessened risk than other organs for toxicity. Certain patients, however, may be at a higher risk for developing peripheral nerve toxicity due to genetic or metabolic factors. Many therapies have toxicities that must be tolerated because the treatments are necessary, such as treatments for HIV and malignancy. Developing additional therapies to prevent and/or ameliorate the toxic neuropathy associated with certain medications is an important area of  research and clinical trials are on-going.

2015 UPDATE:  Reports from the FDA information on Fluoroquinolone has noted significant instances of chronic peripheral neuropathy.  Military doctors wrote 1.2 million scripts for this drug during the Gulf War and many believe that it is the cause of the Gulf War Syndrome or Fluoroquinolone Toxicity Syndrome.

1 Brody, Jane. “The Many Ills of Peripheral Nerve Damage.” The New York Times, October  20, 2009.

2 Zimmer, Carl. “Answers Begin to Emerge on How Thalidomide Caused Defects.” The New York  Times, March 16, 2010.

See: Textbook of Peripheral Neuropathy, Peter D Donofrio, MD, Editor, Professor of Neuropathy, Chief of Neuromuscular Section, Vanderbilt University Medical Center, Nashville, TN Published by DEMOS Medical, 2012.

About the Author

Peter D. Donofrio, M.D. - Chief of the Neuromuscular Section in the Department of Neurology at Vanderbilt University

Dr. Donofrio accepted the position of Chief of the Neuromuscular Section in the Department of Neurology at Vanderbilt University in 2006. He is also the Head of the Muscular Dystrophy Association Clinic, the ALS Clinic, and is the Director of the EMG Lab. Dr. Donofrio sits on the Board of Directors of the American Academy of Neuromuscular and Electrodiagnostic Medicine (AANEM) and serves on the Medical Economics and Management Committee of the American Academy of Neurology.

Author Archive Page


  1. Five years ago I was prescribed Ofloxacin, a fluoroquinolone (FQ) antibiotic to treat a MRSA virus infection following a joint replacement surgery. I took 41 doses of 400 mgs. My feet began burning shortly after taking the drug. I told my VA doctor about the connection. He dismissed it and instead tested me for diabetes and assumed it to be in my head (somatic). Eventually I convinced a VA doctor that there may be a connection after I convinced her to look at the FDA website and see the Safety Alert on fluoroquinolones. Eventually I was given an EMG/NCS and the old neurologist wrote in his report that I did not have a PN. That was in Jan 2013. It has taken me until last week to convince another VA doctor to give me a consultation by another doctor after educating him about the differences between LFN and SFN. Add fluoroquinolones to the list in this article. The Air Force Times reported last year that military Docs/PAs wrote 1.2 million prescriptions between 2009-2012. Many docs and researchers believe that Gulf War Syndrome is actually Fluoroquinolone Toxicity Syndrome. The symptoms are identical. Thanks for the great articles.

    1. Mark: I will add Fluoroquinolone to our articles. For the record, the EMG and NCS do not rule out neuropathy as there is NO test that does this for a patient. The only POSSIBLE exception is the skin biopsy for SFN which will confirm damage and MAY rule out SFN. Many of the SFN’s are immune mediated and if so can be treated with IVIg. Otherwise, all these tests do is note if there has been damage to the nerves and the extent of damage… Ignorance spreads faster than fact even among the intelligent. And you are welcome. I will send you an e mail with other information.

      1. Col Richardson: Thank you for adding fluoroquinolones to the list. This class of drug is responsible for many other adverse drug effects to include tendon problems (FDA Black Box warning), CNS problems, mitochondria toxicity, etc. It is a very big issue for many people, myself included. There are two websites that have lots of information and links: and Also, I would like to correct your posting of the fluoroquinolones to this article. The 1.2 million prescriptions was given in 2009-2011. During the Gulf War, Cipro (a FQ) was given out to the Soldiers and Marines as a preventative measure against anthrax. See the Airforce Times 2013 article “New FDA warnings on Cipro may tie into Gulf War illness”.
        And lastly, fluoroquinolones have been used as chemotherapy or as an adjunct to existing chemotherapy because of there apoptotic properties. For a quick summary of Fluoroquinolone Toxicity Syndrome and a list of medical research, query, Dr. Miriam J. de Jonge’s “Dear Colleague” letter. I believe there is a link to it on the site.
        Thank you for your dedication in educating people about neuropathy. I served in the Army with Vietnam veterans who were suffering from the effects of Agent Orange. It is devastating.
        May GOD bless you and your efforts on this website.

  2. I was treated with Bactrim for an ear infection (primary care Doc thought it best due to my A Fib status). All hell broke loose and my blood went south (liver, etc) It came back in 2-3 wees with further testing , but then I was notified that I had a positive reading for ANA. Since that time I developed many Lupus, Sjorgren’s type symptoms including burning feet. It is now October and the burning has intensified. The recent blood work indicated negative for those diseases and other autoimmune antibodies. But, my recent EMG testing from a neurologist indicated SFN. I am now on 25mg Lyrica twice daily with some relief.

    1. Terry: Small Fiber Neuropathy is confirmed with a simple skin biopsy. See the article on skin biopsy on the website for small fiber neuropathy and speak to the doctor as this needs to be confirmed. Second many SFN’s are immune mediated and can be treated with IVIg. Please see these two links and speak to the doctor if this might be true in your case as it would seem that something in your history notes that your immune system is involved. Small Fiber Neuropathy see: Skin Biopsy see: and IVIG

    2. You might want to look into that lyrica. I was on it and had horrible side effects. I also read it caused tumors in mice but not rats, unknown what it does to the human body. Also had bad withdrawals. I was also posioned by cipro & leva, still recovering been almost a yr.

      1. Brenda: Yes Lyrica and many of the drugs have POSSIBLE side effects yet some people do fine on it and it reduces the neuropathic pain for them. All drugs must be used with caution and if side effects are worse than the symptoms then other options need to be explored. Our bodies for a number of reasons are different and how we react to drugs is a very personal fact. I remember when I was put on one of the seizure drugs and began to talk backwards or could not put a sentence together. Not fun… but of course we stopped it yet I did well on Nortriptyline which also helped me sleep while taking away 85% of my pain. Working with the doctor who has some training in the issues of drugs is very important for neuropathy patients until they find what works for them and this may be a nondrug option such as biofeedback or a topical compound as mentioned in the article.

        1. All the uproar about Lyrica can be found on the askapatient website, which put fear in me while I was on that drug, yet I felt none of the symptoms except small orgasm. I was up to 300mg a day and felt I could do better not taking it. That was a big mistake as I have the worst neuropathy pain now that is totally uncontrolled. I cannot go back to Lyrica as I lost my insurance so I have asked my VA doc to try Cymbalta as my neuropathy is currently very progressive.

          1. Evan: I had difficulty with all the drugs with serious side effects…. the one that helped me was Nortriptyline and it is an old drug of the same class as Cymbalta so the VA may give it. If taken at night as they work you up to the recommended dosage of 75 mg it also helps you sleep. Will send more information from our e mail address.

    3. Severe reaction to Bactrim after taking a single dose for UTI in Nov 2015. Never experienced this type of pain. Would rather experience labor all over again giving birth to my 4 children back to back. Started in back of both legs and then 5 or so hours later both arms. Only way to describe is to compare to cramps, only my muscles were NOT tight. Internist, neurologist and orthopedic doctors all said was not because of the Bactrim. Multiple blood tests, MRIs and nerve tests. Only positive result was confirmation that both arms and legs did have neuropathy. Neurologist discovered my feet had no dorsey flex ability. It’s been a year now and although dorsey flex has improved, I still do not feel 100%. So frustrating! I now have a burning sensation on the top of both my feet. Walking or standing too long increases this and makes me feel 100 years old! Anybody have suggestions on what to do next? I stopped going to neurologist, as he really wasn’t much help. HELP!

  3. I’ve been suffering with issues since taking Cipro 4 years ago and have been diagnosed with mild peripheral neuropathy among a few other things. I’m not sure how they decide its mild as it keeps me immobile and many sleepless nights due to pain. I’ve been seeing a wellness chiropractor 3 days a week for 4 months now and it has helped somewhat, but my PCP dumped me for not following her prescription regiment which included pain and antidepressant meds that I did not want to take. What type of doctor can do a puncture test for SFN? I would really prefer to not have to go back to a new PCP as after 4 attempts they all deny fluoroquinolones could have caused the damage and they all want to give me another medication to mask the problem. Any help or advice would be appreciated.

    1. Traci: Here is the warning from : Ciprofloxacin may cause nerve damage that may not go away even after you stop taking ciprofloxacin. This damage may occur soon after you begin taking ciprofloxacin. If you experience any of the following symptoms, call your doctor immediately: numbness, tingling, pain, or burning in the arms or legs; or a change in your ability to feel light touch, pain, heat, or cold. If you experience these symptoms, do not take any more ciprofloxacin until you talk to your doctor. Your doctor may prescribe a different antibiotic for you to take instead of ciprofloxacin. Ciprofloxacin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online [at or by phone [1-800-332-1088].

      In the Textbook of Peripheral Neuropathy by Peter Donofrio Professor of Neurology, Chief Neuromuscular Section, Vanderbilt University Medical Center Nashville published 2012 by DEMOS Medical, he states on page 205 that Fluoroquinolone absolutely DOES CA– USE a polyneuropathy but unlike the National Institute of Health, notes that ‘patients typically recover within 2 weeks when the medication is stopped”. I would assume that some patients are not ‘typical’ when it comes to such recovery which we know is true from any types of neuropathy!

      I will send you a separate E Mail in regards to these issues and other information.

  4. Hi,
    I have terrible nerve pain and muscle atrophy in my arms and a bit in my legs with burning feeling in my arms and hands and knees especially the inner part of my knees. I have RA and celiac and was wondering if you think this pain is related to that or perhaps to the fact that i took Humira again straight after i finished 4 months of breastfeeding as that is when my arms started to atrophy. ?

    1. Carol: You need to be evaluated by a Hematologist and a Neuromuscular Neurologist. Celiac disease is a known cause of Peripheral Neuropathy according to Dr. Latov PhD MD of Weill Medical College of Cornell University but it would be more likely that the Drug Humira is causing many of these symptoms especially the muscle wasting and other symptoms. Please see a Hematologist or other related specialist ASAP and then follow up with an evaluation by a Neuromuscular Neurologist.

  5. I would like to add that physicians are not aware of these issues. I found out too late. Unless you r fortunate to see a very informed neurologist, these devastating adverse effects will never b recognized or reported which leads to a vast under reporting of events.

    1. CW: Physician training and education is one of the MOST critical areas in the field of Peripheral Neuropathy. We have come a long way in this regard. I will send you some information on resources that may help you by separate E mail. Col Gene

  6. I have a diagnosis of SFN having 1.8 small working fibres to the mm when it should be between 5 and 8. The only thing tests revealed was B6 toxicity. Having stopped taking B6 for approx 8 months my levels have returned to the high end of normal.
    I have all the usual SFN symptoms but they are manageable. What plagues me is terrible itching. starting as soon as I get up in the morning. It can go on for hours, is mostly in my arms and legs and is triggered by change of temperature. I can’t shower in the mornings, have to heat my clothes to try and maintain my temperature.The temperature yesterday here was 30 degrees and i had a swim in a friends pool which was also at a very warm temperature. However, that started and itching attack which went on for about an hour until my body temperature got back to normal. I also frequently have mega sweats Any exertion causes these and I never feel comfortable!
    I am 65 , have had the sweats for 17 years which I put down to menopause and have had the itching for 7 years.
    I was at one point put on HRT as they thought the sweats and itching were caused by a hormone imbalance.
    After 11 months I was diagnosed with oestrogen receptive breast cancer so of course came off the HRT. Two operations , (Nov and Dec 2015) They also inserted a Mirena coil (progesterone) for 7 months and my SFN symptoms escalated dramatically causing major icy sensations. I spent the whole time swathed in blankets to feel tolerably warm.! I begged to have the Mirena coil removed and things improved re the iciness.
    Can SFN be caused by hormone imbalance ? If the B6 toxicity was the main cause for my SFN is there a chance that my small fibre nerves can repair? Are these extreme itching and sweating bouts normal for SFN? My neurologist has now referred me to an immunologist as my itching went away for short while when I was ill with a sickness bug and didn’t eat for 4 days.
    However, the itching feels like an allergy to the cold although I don’t get any hives etc. if it was a food allergy I’m thinking I would get the effects at varying times depending on my diet. could it just be the effects of the temperature on my damaged nerves?
    I’m so exhausted with all this and desperate to find some solution without resorting to taking Lyrica as I have two friend who’ve tried it and both had extremely adverse effects.
    Any help would be greatly appreciated.

  7. I have been diagnosed with peripheal neurapathy about eight years ago. The pain started in my feet. It is not diabetic. I suffer many dibelitating problems that my doctor tells me all are from the neuropathy. I alone think and feel strongly about that seroquil somehow caused this. I was given seroquil after my husband died suddenly and my doctor thought it would help me through the grief. After a few years i weaned myself off. Almost immediately my feet started to tingle. They don’t tingle any more. They burn like standing in ice water. They have bolts of electricity hitting them at times. There are time they feel like they just been beat up. I also have chronic gastrointestinal issues that come and go for no apparent reason. My face has red blotches and scaley patches and bloody pustules come and go for no reason. I use finasea cream on it. It is very expensive but does help with the bumps and scales. The blotches never go away. Chronic fatigue never goes away. Also over heating with sweating profusely is problably the most debilitating. I’m not sure what’s the worst. Seroquil did loose a class action suit for causing diabeties but they won’t admit to neurapathy. I also had a heart attack but the cardiologist could find no reason whatsoever why. He too wonders if it had something to do with my neuropathy. I take 2400 mgs of neurotin a day. Sometimes less if I’m having a good day which are few. The doctors I’ve seen have all told me I will not get better. Ever.
    I do have many medications for every symptom that I taje as needed but each med has it’s own side effect. Chronic fatigue is probably the worst because it keeps me from even looking further for help.
    Is there any help for me.
    I can’t say I itch necessarily, I thought the itching was from a medication I take. But showering is an all day event because the changes in tempature of the water and skin gets all my nerves inflamed. I’m sweating even under a cool shower but my feet are burning. I spend most my time in bed. My feet u see an electric blanket and an air conditioner in my face. Any suggestion whatsoever would be so appreciated. Much thanks

  8. Dr
    I have what is somewhat urgent need for answer. I feel/ believe that my daughter age 19 diagnosed with Relapsing Remitting Multiple Sclerosis age 12, and with Dysautonomia as well. She has postural orthostatic tachycardia syndrome. The treatment at this present time is Gammunex – C 30 GM load and 250 mg solumedrol pre /post. This was not her starting dose. I will hive more detail and lead up to the event in question and hope you can help me. She has been on this regimen since May 13th with varying dates of treatment due to exacerbation of MS on May 3rd, 2016. Initially she was on this regimen every other day starting May 13th, 16th, 18th, 20th until flare was under control then anestheologist agreed to general anesthesia and surgeon placed Bard brand Central Subclavian port on May 25th, 2016. Immediately after surgery 1,000 mg divided pre / post with Gammunex C was given. Dr then spread her treatment to every other week with treatment dates 6/1, 6/8, 6/15, 6/28. On the 6/15 date of service, her steroids was reduced to 500 mg solumedrol divided pre / post with Gammunex – C 30 GM load infused. Her body weight is 115-120 lb, or 56.4 kg at present. To insert she had been doing well enough to then spread treatment to every 2 weeks using same regimen of 500mg solumedrol pre / post solumedrol with Gammunex C 30 GM. Continuing treatment dates are as follows, 7/13, 7/27, 8/9, 8/25, 9/7/, 9/23. It us here on this service date that immediately day after treatment 500 mg dividea dose solumedrol with Gammunex C 30 GM load that her probkem began. I will explain some of her history of this flare in May 3rd, 2016. She has CNS lesions in addition to C3-4, C 5-7, T 5-6, T 9-10 new lesion on her MRI scan 3/15/16. Her flare symptoms began as visual blurring right eye, numbness starting at neck Right side, following each day more to waist, hip, thigh, then all way to foot, then crossing over to left foot coming up to calf, thigh, chest and stoped at collarbone. Then developed vertigo. No facial numbness. All resolved completely with minimal weakness after may 13th thru may 25th treatment dates listed above. However as we spread out treatments, she was doing well. Then day after 9/23/16 treatment date, she had numbness, tingling, and feet were very cold feeling to her and in fact were cold to touch. I relieved this by warming with shower water, warm blankets, and very closely monitored warm moist heating pad. I will stress WARM heating pad, not low, medium or hot setting. I am extremely cautious about using dry heat. We were at ger Dysautonomia Dr in Birmingham Dysautonomia and MVP Ctr. Her EKG was good. Showed only bradycardia at 56 BP heart rate. I thought that nay be reason for cold feet. Feet did have color change, more splotchy and some red at tip if toes. Cold to touch. The numbness started at tips of toes on underside and progressed to heel of both feet only on soles if feet. Did not go to top of feet at this point. We were away from home 3 days and her feet remained cold. On Friday 9/30/16 driving home, symptoms if numbness started to ascend upward left side of chin, then thigh, and waist in one day. Then subday Oct 2nd, she woke with numbness up to chest. I called her Dr Monday. We started treatment of ivig Gammunex C mixed with 500mg solumedrolike divided pre and post IVIG. Thus is an 8 hr infusion for her. She slept through most of treatment and awoke with numbness resolving very well. I felt it to be MS fkare. As confirmation by getting better by treatment. Dr didn’t do anymore ivig that week, only 500mg solumedrol daily Wed, Thur, Fri- 10/6/16. On Friday her soles began to tingle, numbness and burning hot soles. But in fat the soles of feet were hot to touch, but no redness at all. This continued through Sunday with pain developing and she couldn’t stand for them to be touched, almost as hypersensitive. I called her Dr Sunday and explained to him in meticulous detail and told him she never had this before post treatment. I was concerned. He wanted her to return today Monday 10/9/16 for aggressive treatment with same IVIG and still 500mg solumedrol divided pre / post IVIG. He wants treatment Wed and Fri with Solumedrol 500mg. I question not using combined same treatment of ivig/solumedrol plan but increasing to 1,000 mg for 3 days. Only because when she was treated with combined ivig and steroids week before it was more effective than just other 3 days of Solumedrol alone. I’m concerned there may be a drug induced Peripheral neuropathy starting. But I’m only experienced in this by some of my own PN after drug induced PN after IgA vasculitis started after sudden adult onset anaphylaxis to either eggs or nuts. No qualified Dr to identify what really happening to prevent my vasculitis from ravishing my legs, feet, body without steroid control in time. I wound up at Cleveland Clinic from Mobile Al, as my husband was desperate for help for me and my legs were gray as in near gangrene. My problem aside, I was left with peripheral pain in feet, hands, legs, arms. For year I suffered until I asked Dr to try me on Lyrica. It worked almost within 24-48 hrs and in some control now. Said all about me to say this, I don’t want my daughter to suffer misdiagnosed situation and then have permanent neuropathy. I need help, answers and quick. After receiving her solumedrol this morning and starting IVIG, her feet are now physically hot to touch and she’s very uncomfortable. I suffer from MS also and know how pain is. I also think her Dysautonomia could be cause. Also her MS. But she has never had unrelenting numbness, tingling for her MS that didn’t subside with treatment. This is puzzling and I need advice soon. I will bring her to Vanderbilt if that’s where you are. Also her Dysautonomia Dr went to shool at Vanderbilt and told me of Dysautonomia clinic there. Know lot of info but if you can help, please email me. I will list all meds she had taken on the 9/24/16 visit. 50 mg Benadryl, 650 mg Tylenol, prilocaine cream to numb her skin before port access, prilosec 20mg, Fluorinef .2mcg increase BP, Caltrate 600 D, Vitamin D3 5,000mg daily at present-level 45, klonopin 1mg tab 2x day for Restless leg syndrome, Tizanidine 4mg 2x day for MS spasticity, 75 mg Zolloft for depression due to exacerbation in May and not able to continue and start her 2nd year in college. Ambien 10mg taken in days if steroids to help sleep. Multi-vitamin nit super kind, Gummi kind brand Vita Fusion. Does have B vitamins, but none in excess of 100% in one’s with possible toxicity, but B12 is 200% RDA.
    Renee McCowan

  9. Dr, my daughter is age 19, will be 20 in Feb 2017. She is not age 12 at present. After re-reading my post, it appears I’m discussing a pediatric case. I apologize
    Renee McCowan

  10. I had peripheral neuropathy in my right arm after taking a week of Nitrofurantoin for a urinary tract infection about 2 months ago. It lasted for about 2 weeks and completely resolved after. I have another urinary tract infection and I went to the doctor today, told him about my peripheral neuropathy with macrobid. He dismissed it and wasn’t aware of it. I had to look up side effects for it onmy phone to show him about it. He then gave me a prescription for bactrim, which is sulfamethoxazole. I didn’t see it on your list but I saw in one of the previous comments that someone had problems with it. I’m afraid to take it. Is there a way to predict such occurrence with another antibiotic?

    1. Renate: Will send an E mail with information but be patient I am behind two weeks worth of work in helping patients. the textbook by Dr. Peter Donofrio MD does not list sulfamethoxazole but he notes that the lists of drugs implicated in causing peripheral neuropathy grows everyday. His textbook is a great resource for doctors but you are interested you can purchase a copy at this link from amazon. MEDICAL: Textbook of Peripheral Neuropathy by Peter D. Donofrio MD FAAN 2012 Professor, Vanderbilt Medical School, Nashville, TN Excellent:

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