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  • Updated 05.20.2024
  • Released 07.05.2000
  • Expires For CME 05.20.2027

Drug-induced neurologic disorders



The term “drug-induced neurologic disorders” refers to unintended or undesirable effects on the nervous system that are either caused by drugs or associated with drug use. These may be drugs for neurologic or other diseases. This article discusses the pathophysiology, epidemiology, diagnosis, and treatment of drug-induced neurologic disorders. The toxic effect on the nervous system may be primary or secondary to systemic effects of the drug. Pharmacogenetics, the study of the influence of genetic factors on the action of drugs, is relevant to adverse drug reactions. Polymorphisms in the genes that code for drug-metabolizing enzymes, drug transporters, drug receptors, and ion channels can affect an individual's risk of having an adverse drug reaction. The approach to management includes both prevention and withdrawal of the drug responsible for the adverse reaction. Genotyping may identify patients who would develop adverse reactions to certain drugs; if possible, those drugs should be avoided in the identified subsets of patients.

The emphasis of this article will be on commonly observed primary neurotoxic adverse drug reactions. The following are outside of the scope of this chapter: (1) substances that are not prescription medicines (eg, illicit drugs, industrial chemicals, environmental toxins, venoms, phytotoxins, and mycotoxins, regardless of whether they have neurotoxic potential); (2) intentional overdose or misuse of prescription medicines (although a few will be mentioned when they have relevance to a scheme for organizing neurologic adverse drug reactions); (3) non-neurologic adverse drug reactions of drugs used to treat neurologic disorders. It is also not possible to cover in depth all primary neurotoxic effects; the review of individual case reports of all alleged adverse drug reactions (many of which are noncausal temporal associations); "secondary" neurotoxic effects resulting from systemic drug effects; all drug-drug, drug-diet, or drug-gene interactions; or research processes for establishing causality in randomized controlled trials or pharmacoepidemiology studies, or the techniques of pharmacogenetics and pharmacodynamics.

Drug-induced disorders of the nervous system are also discussed in numerous other MedLink articles.

Key points

• Drug-induced neurologic disorders are unintended adverse effects on the nervous system that are either caused by drugs or associated with drug use.

• Drug-induced neurologic disorders should be considered in the differential diagnosis of neurologic disorders.

• Adverse drug reactions may be reversible on discontinuation of the responsible drug, but neurologic damage may persist in some cases.

• Awareness of adverse drug reactions is important for improving the safety of pharmacotherapies.

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