Pyridoxine and Pyridostigmine Treatment in Vincristine-Induced Neuropathy

Abstract

Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.

Clinical challenges associated with bortezomib therapy in multiple myeloma and Waldenströms Macroglobulinemia

“…Nutritional supplements such as α -lipoic acid [41], glutamine [41,42], and L-carnitine [43] exhibit neuroprotective properties that provide rationale for their use in patients with MM who receive neuropathic drugs such as bortezomib, although prospective studies are needed to validate their efficacy in this setting. Vitamin B6 (pyridoxine) supplementation may also benefit patients receiving potentially neurotoxic therapy [44]. However, a high serum level of vitamin B6 is itself neurotoxic and so must be avoided.…”

Vincristine-induced polyneuropathy in a child with stage I Wilms’ tumour presenting with unilateral abducens nerve palsy

“…There are several clinical reports of using pyridoxine, pyridostigmine and glutamic acid as a prevention or treatment of the neurotoxicity. Pyridoxine alone or in combination with pyridostigmine is more widely used 4 7. Pyridoxine, levocarnitine and N -acetylcysteine have been used together in a neonate with good results 15.…”

Vincristine-induced vocal cord paralysis in a patient with acute lymphoblastic leukemia

“…It may be unilateral (typically left side) or bilateral and can require intubation or surgical intervention, e.g., cordotomy to maintain airway patency [4].The neuropathy typically resolves following cessation of the drug, however recovery times vary, from days to months [4]. There is no convincing data of definitive pharmacological measures to treat vincristine-associated neuropathy, however there are case reports suggesting the use of pyridoxine and pyridostigmine [5] or glutamic acid [6] to be of benefit.…”