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Editor, – While a short article cannot be encyclopaedic, 'The use of anticonvulsants for neuropathic pain' (Aust Prescr 1999;22:140-1) omits to mention prescribed drugs in the potential causes of peripheral neuropathy. Exclusion of a pharmacological cause should be one of the earliest steps in the management of this disorder, although in some cases symptoms continue to worsen for some time after ceasing the culprit drug.
The association with certain antineoplastic drugs is well known, but there are many other medications that may cause neuropathy, including commonly prescribed drugs such as metronidazole, nitrofurantoin, isoniazid and daps one, as well as some anti-HIV drugs. Phenytoin and pyridoxine, which may be used in the treatment of neuropathy, may themselves, albeit rarely, cause the condition.
These patients are often desperate for relief of symptoms, and there is a natural desire on the part of their doctors to 'do something'. As the author points out this can be unhelpful or harmful.
Sexual Health Unit
Alice Springs, NT