Medications That Cause Numbness and Tingling

Chemotherapy-Induced Peripheral Neuropathy (CIPN)

The American Society of Clinical Oncology recommends that taxanes and platinum compounds are the primary culprits of chemotherapy-induced peripheral neuropathy, affecting 30-40% of patients 1, 2
Paclitaxel causes predominantly sensory neuropathy with numbness and tingling more prominent in lower extremities during treatment, typically improving over several months after completion 2
Oxaliplatin produces acute cold-induced symptoms and chronic neuropathy that paradoxically worsens for 2-3 months after stopping treatment, with upper extremity symptoms initially more severe than lower 2
Vinca alkaloids affect small nerve fibers and can cause autonomic involvement with abdominal pain, constipation, and postural hypotension 3
Bortezomib causes small fiber neuropathy with burning sensations in hands and feet 3
Thalidomide produces sensory neuronopathy affecting dorsal root ganglia, often irreversible 3

Symptoms of chemotherapy-induced peripheral neuropathy begin as numbness and tingling in fingers and toes in a symmetric "stocking-glove" distribution, with sensory symptoms appearing earlier and being more prominent than pain 2, 3

Up to 50% of postmenopausal women on aromatase inhibitors report joint pain and muscle pain, with 20% experiencing severe enough symptoms to cause treatment discontinuation 4, 5
Numbness is reported in 29-81% of breast cancer patients on systemic therapy 5

The American Society of Clinical Oncology recommends screening for pre-existing neuropathy before starting neurotoxic medications 1
Duloxetine is the only evidence-based pharmacologic treatment for painful peripheral neuropathy with numbness and tingling, and is recommended as first-line therapy 2, 4, 6
Non-pharmacologic interventions with supportive evidence include physical activity and exercise therapy, acupuncture for pain management, and acetaminophen and NSAIDs for associated pain 2, 4, 5, 6
Gabapentin/pregabalin, tricyclic antidepressants, and topical amitriptyline/ketamine preparations are not recommended based on current evidence 2, 7
Acetyl-L-carnitine may worsen symptoms and is not recommended 1