What Meds Cause Pallesthesia? Exploring Drug-Induced Nerve Damage

October 11, 2025 •

3 min read

According to Memorial Sloan Kettering Cancer Center, peripheral neuropathy affects 30% to 50% of patients receiving certain types of chemotherapy. This nerve damage can lead to pallesthesia, a reduced or absent sense of vibration, along with other sensory and motor disturbances.

Quick Summary

This article examines various medications known to cause peripheral neuropathy, leading to a loss of vibratory sensation. It details the classes of drugs responsible, the mechanisms of nerve damage, and how symptoms manifest, emphasizing the importance of recognizing and managing these adverse effects.

Key Points

Chemotherapy Agents: Platinum-based drugs like cisplatin and taxanes, including paclitaxel, are highly neurotoxic and are common culprits of chemotherapy-induced peripheral neuropathy (CIPN), leading to pallesthesia.
Fluoroquinolone Antibiotics: Medications such as ciprofloxacin and levofloxacin can cause nerve damage that may manifest as a loss of vibratory sensation, and in some cases, the effect can be permanent.
Cardiovascular Drugs: Chronic use of certain heart medications, like amiodarone, can lead to a dose-dependent peripheral neuropathy that impairs sensory perception.
Immunosuppressants and Other Medications: Thalidomide, phenytoin, and immunosuppressants like tacrolimus are known to cause nerve damage that can result in pallesthesia.
Toxic Exposures: In addition to prescription drugs, alcohol abuse, and exposure to heavy metals such as lead and mercury, can cause nerve damage and loss of vibratory sense.
Reporting Symptoms: Any new or worsening sensory symptoms like numbness, tingling, or difficulty with balance should be reported to a healthcare provider immediately, as early intervention may help prevent permanent damage.

Pallesthesia is the sensation of vibration, and its loss can indicate nerve damage, often from drug-induced peripheral neuropathy (PN). Many medications are toxic to peripheral nerves, causing symptoms like numbness, tingling, and reduced vibration sense. This article explores drug classes linked to pallesthesia and drug-induced PN.

Chemotherapy Drugs and Neurotoxicity

Chemotherapy-induced peripheral neuropathy (CIPN) is a common cause of nerve damage in cancer patients. Several agents are significantly neurotoxic and can cause severe, sometimes permanent, sensory nerve damage, often starting in the hands and feet.

Platinum-based drugs: Cisplatin and oxaliplatin can cause dose-dependent sensory neuropathy, with risks increasing with treatment.
Taxanes: Paclitaxel and docetaxel can cause painful sensory neuropathy early in treatment.
Vinca alkaloids: Vincristine can disrupt nerve cell transport, affecting sensory and motor nerves.
Proteasome inhibitors: Bortezomib can damage dorsal root ganglia, leading to sensory neuropathy and pallesthesia.

Antibiotics and Nerve Damage

Some antibiotics can cause drug-induced peripheral neuropathy, especially with prolonged or high-dose use.

Fluoroquinolones: Ciprofloxacin and levofloxacin pose a risk of potentially permanent peripheral neuropathy, with symptoms possibly lasting for years.
Isoniazid: This antituberculosis drug can cause neuropathy by interfering with vitamin B6 metabolism, often managed with B6 supplements.
Metronidazole: Long-term or high-dose use can lead to peripheral nerve damage.
Nitrofurantoin: This urinary tract infection medication is another potential cause of peripheral neuropathy.

Cardiovascular and Immunosuppressant Medications

Some heart and immunosuppressant drugs are linked to nerve damage that can cause pallesthesia.

Amiodarone: Chronic use can cause dose-dependent peripheral neuropathy.
Thalidomide: Used for certain cancers and autoimmune diseases, thalidomide has a known risk of sensory neuropathy.
Calcineurin inhibitors: Tacrolimus and cyclosporine, used to prevent organ rejection, have been associated with nerve damage.

Other Medications and Contributing Factors

Other drugs and factors can increase the risk of pallesthesia and PN.

Anticonvulsants: Long-term use of drugs like phenytoin can contribute to peripheral nerve damage.
Alcohol and Heavy Metals: Alcohol abuse is a common cause of polyneuropathy. Heavy metals like lead, mercury, and arsenic, found in some unregulated supplements, can also damage nerves and affect vibration perception.
Vitamin B12 Deficiency: Prolonged deficiency can affect the spinal cord and lead to a loss of vibratory sensation.

Comparison of Drug Classes Causing Pallesthesia


Drug Class	Examples	Typical Onset	Mechanism of Damage	Potential for Recovery
Chemotherapy	Cisplatin, Oxaliplatin, Paclitaxel	Can be rapid, often dose-dependent	Direct nerve damage, disruption of nerve cell transport	Varies; can improve after cessation, but sometimes permanent
Fluoroquinolone Antibiotics	Ciprofloxacin, Levofloxacin	Can be rapid, within days to weeks	Thought to affect nerve cells directly; mechanism not fully understood	Varies; can be temporary, prolonged, or permanent
Antituberculosis Drugs	Isoniazid	Prolonged use, dose-dependent	Interference with Vitamin B6 metabolism essential for nerves	Often reversible with supplementation and drug discontinuation
Cardiovascular Drugs	Amiodarone	Chronic use, dose-dependent	Accumulation of drug in nerve tissue, direct toxicity	Slow and often incomplete recovery after drug is stopped
Immunosuppressants	Thalidomide, Tacrolimus	Variable, depends on duration and dose	Dose-dependent toxicity, damage to dorsal root ganglia	Varies; some permanent damage may occur

Conclusion

Drug-induced pallesthesia is a serious side effect resulting from nerve damage caused by various medications, including chemotherapy, certain antibiotics, and long-term heart and immunosuppressive therapies. The nature and onset of damage vary depending on the drug. Promptly reporting symptoms to a healthcare provider is essential. Adjusting or stopping the medication might lead to improvement, but nerve injury can be permanent. Monitoring and patient education are vital for managing these adverse effects.

Drug-Induced Peripheral Neuropathy - Foundation for Peripheral Neuropathy

Frequently Asked Questions

Pallesthesia is the medical term for the sense of vibration. It is tested during a neurological exam using a tuning fork placed on bony prominences like ankles, knees, or fingers to check if the patient can feel the vibration.

No, the permanency of nerve damage varies depending on the specific drug, dosage, duration of use, and individual patient factors. Some effects may resolve after the medication is discontinued, while others can be long-lasting or permanent.

While less common, some over-the-counter drugs, particularly long-term use of certain nonsteroidal anti-inflammatory drugs (NSAIDs) or excessive intake of certain vitamins like B6, can potentially contribute to neuropathy and sensory issues.

Diagnosis typically involves a thorough medical history, physical examination, and neurological tests like nerve conduction studies and electromyography (EMG) to assess nerve function.

Treatment for chemotherapy-induced peripheral neuropathy (CIPN), which includes pallesthesia, often involves supportive care. Medications like duloxetine may help with neuropathic pain, and physical therapy can assist with balance problems.

You should contact your healthcare provider immediately. They will assess your symptoms and determine if the medication needs to be adjusted, discontinued, or replaced with an alternative.

Some nutritional issues, like vitamin B12 deficiency, can cause pallesthesia, and supplementation may help in those cases. However, you should discuss any dietary changes or supplements with your doctor, as some, like excess vitamin B6, can be harmful.