To prevent polyneuropathy, attention must be paid to reducing individual risk factors.
Behavioral risk factors
- Diet
- Foods containing acrylamide (Group 2A carcinogen) – formed during frying, grilling, and baking; used to make polymers and dyes; acrylamide is metabolically activated to glycidamide, a genotoxic (“mutagenic”) metabolite
- Micronutrient deficiency (vital substances) – see prevention with micronutrients.
- Consumption of stimulants
- Alcohol (= alcohol-associated polyneuropathy) → sensitive symptoms, such as numbness, stinging, or gait unsteadiness.
- Tobacco (smoking); moderate association between smoking and diabetic peripheral neuropathy (DPN).
- Drug use
- Nitrous oxide (due to chronic abuse with the party drug laughing gas).
- Poor adjustment of glucose serum levels (blood glucose levels).
Medication → toxic polyneuropathy
- Anti-infectives – quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin), chloroquine (D), dapsone (A), dideoxycytidine, isoniazid, nitrofurantoin (A), metronidazole (A), thalidomide.
- Antiarrhythmics – amiodarone (G), flecainide (A), procainamide (D).
- Antirheumatic drugs and immunosuppressants – chloroquine, colchicine, gold, tacrolimus.
- Bortezomib (proteasome inhibitor) (A).
- Digoxin (cardiac glycoside) (A)
- Hydralazine (antihypertensives) (A)
- Immune checkpoint inhibitors (such as ipilimumab, nivolumab, and pembrolizumab) → acute inflammatory demyelinating or axonal polyneuropathies (AIDP [acute inflammatory demyelinating polyradiculoneuropathy]/ASMAN [acute sensorimotor axonal neuropathy]/AMN [adrenomyeloneuropathy]) and CIDP.
- Immunomodulators – Tacrolimus (D).
- Immunosuppressants – leflunomide (A)
- Interferon-α (A)
- Levodopa (antiparkinsonian drug) (A)
- Lithium (A)
- Gold (G)
- Psychiatric medication and sedatives – disulfiram, lithium.
- Phenytoin (A)
- Reverse transcriptase inhibitors
- Statins (A)
- Thalidomide (A)
- TNF-α antagonists (D)
- Tuberculostat – isoniazid (A).
- Vitamin B6 overdose (A)
- Cytostatic drugs (chemotherapy-induced neuropathy (CIN)) – doxorubicin (A), etoposide (A), gemcitabine (A), ifosfamide (A), platinum(derivatives) (A), cisplatin, vincristine, vinca alkaloids (A), taxanes (A; e.g., paclitaxel)), taxol (A), or proteasome inhibitors.
Legend: A = axonal; D = demyelinating; G = mixed axonal-demyelinating.
Environmental exposures – intoxications (poisonings) → toxic polyneuropathy.
- Arsenic
- Hydrocarbons
- Heavy metals such as lead, thallium, mercury
- Carbon disulfide
- Trichloroethylene
- Triorthocresyl phosphate (TKP)
- Bismuth (due tobismuth-containing dental material or in the case of long-term treatment with bismuth preparations).