Neurotoxic Medications

The medications listed below are potentially toxic to CMT patients. Vincristine has been proven hazardous and should be avoided by all CMT patients, including those with no symptoms.  Taxols also pose a high risk to people with CMT. The remainder of the medications listed below present varying degrees of potential risk for worsening CMT neuropathy.

Before taking any medication or changing medication, all CMT patients should make sure the treating physician is fully aware of their medical condition.

Definite High Risk (including asymptomatic CMT)

  • Vinca alkaloids (Vincristine)
  • Taxols (paclitaxel, docetaxel, cabazitaxel)

Moderate to Significant Risk

  • Amiodarone (Cordarone)
  • Arsenic Trioxide (Trisenox)
  • Bortezomib (Velcade)
  • Brentuximab Vedotin(Adcetris)
  • Cetuximab (Erbitux)
  • Cisplatin & Oxaliplatin
  • Colchicine (extended use)
  • Dapsone
  • Didanosine (ddI, Videx)
  • Dichloroacetate
  • Disulfiram (Antabuse)
  • Eribulin (Halaven)
  • Fluoroquinolones
  • Gold salts
  • Ipilimumab (Yervoy)
  • Ixabepilone (Ixempra)
  • Leflunomide (Arava)
  • Lenalidomide (Revlimid)
  • Metronidazole/Misonidazole (extended use)
  • Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
  • Nitrous oxide (inhalation abuse or Vitamin B12 deficiency)
  • Nivolumab (Opdivo)
  • Pembrolizumab (Keytruda)
  • Perhexiline (not used in U.S.)
  • Pomalidomide (Pomalyst)
  • Pyridoxine (Although megadoses [10 times or more the RDA] of Vitamin B6 may be harmful, high intakes of vitamin B6 from food sources have not been reported to cause adverse effects.) NIH Fact Sheet
  • Stavudine (d4T, Zerit)
  • Suramin
  • Thalidomide
  • Zalcitabine (ddC, Hivid)

Uncertain or Minor Risk

  • 5-Fluoracil
  • Adriamycin
  • Almitrine (not in U.S.)
  • Chloroquine
  • Cytarabine (high dose)
  • Ethambutol
  • Etoposide (VP-16)
  • Gemcitabine
  • Griseofulvin
  • Hexamethylmelamine
  • Hydralazine
  • Ifosphamide
  • Infliximab
  • Isoniazid (INH)
  • Lansoprazole (Prevacid)
  • Mefloquine
  • Omeprazole (Prilosec)
  • Penicillamine
  • Phenytoin (Dilantin)
  • Podophyllin resin
  • Sertraline (Zoloft)
  • Statins
  • Tacrolimus (FK506, ProGraf)
  • Zimeldine (not in U.S.)
  • a-Interferon

Negligible or Doubtful Risk

  • Allopurinol
  • Amitriptyline
  • Chloramphenicol
  • Chlorprothixene
  • Cimetidine
  • Clioquinil
  • Clofibrate
  • Cyclosporin A
  • Enalapril
  • Gluthethimide
  • Lithium
  • Phenelzine
  • Propafenone
  • Sulfonamides
  • Sulphasalzine

A Note about Alcohol

Alcohol was removed from the neurotoxic drug list in July 2004.  While people with CMT generally suffer no ill effects from the moderate consumption of alcohol, they should be particularly mindful of the fact that alcohol affects balance and coordination, and that overconsumption of alcohol is generally not recommend under any circumstances.  If you have questions about alcohol and your health, consult your physician.

Neurotoxic Medications and Worsening of Neuropathy:

The Charcot-Marie-Tooth Association has long maintained this “Medical Alert” list of potentially neurotoxic medications. It is published on this webpage, in the organization’s quarterly magazine, The CMTA Report, and in a brochure that is distributed along with a “Dear Medical Professional” letter advising physicians treating CMT patients that they should consider the potential risk of prescribing drugs known to have neurotoxic properties. The list is also freely copied and republished.
Click here for an in-depth summary of a study on neurotoxic medications and how they affect CMT patients.

Additional Resources

Full Medical Alert Table

Medical_Alert_Full__Webview_2017_498x385

The Medical Alert 2017 table groups neurotoxic medications by risk category and generic name and provides information about brand names, manufacturers and labeled uses.

It may be downloaded here:

Medical_Alert_Full-Web_4-2017.pdf

Medical Alert  Card

Medical Alert Card 2017

A temporary card may be downloaded here:

Medical_Alert_Card_4-2017.pdf

To request up to four free permanent cards, mail a self-addressed stamped envelope to:

CMT Medical Alert Card
PO Box 105
Glenolden, PA 19036

Be sure to indicate how many cards you are requesting and allow four weeks for delivery.

Dear Medical Professional Letter

Dear Medical Professional Letter

The Dear Medical Professional Letter has a brief description of Charcot-Marie-Tooth disease and the neurotoxic drug list. Give a copy to your physician and any other medical professional who is involved in your care and treatment.

Download it here:

Dear-Medical-Professional_2017.pdf

Get It on the CMTA App

CMTA App

On the go? Get the Medical Alert list of neurotoxic drugs on the CMTA app. Download it now for iPhones at https://appsto.re/us/u3IM8.i or for Androids at https://goo.gl/lNpPxF.