Drug causing maximal peripheral neuropathy is:
First of all let' s revise the drugs causing peripheral neuropathy. These are:
Cisplatin, Amiodarone, Dapsone, Disulfiram, hydralazine, INH, Metronidazole, Nitrofurantoin, didanosine", zalcitabine, stavudine, phenytoin, pyridoxine, statins, Taxol, vincristine
Zidovudine causes myopathy not neuropathy. Hence the confusion is now between stauvdine and didanosine.
didanosine, The most common toxicity is a painful sensory peripheral neuropathy that occurs in -3 0% of patients receiving> 400 mg/dl.
About stavudine - Peripheral neuropathy and hepatic steatosis are the main toxicities.
Thus, according to us, best answer is didanosine. Some frequently asked questions about antiretroviral drugs:
MC side effect of zidovudine - Myelosuppression. Other side effects of zidovudine are: Fatty liver, myopathy, lactic acidosis, cardio-myopathy. Enzyme inhibited by zidovudine resulting in myopathy- DNA polymerase of mitochondriA.
Type of anemia seen with zidovudine →
Macrocytic anemia nonresponsive to B12 IF A
Pancreatitis causing drugs - Didanosine, Zalcitabine, Stavudine
S/E of Didanosine - Pancreatitis, Painful peripheral neuropathy, diarrhea, hepatitis, esophageal ulcer, cardiomyopathy, optic neuritis, steatosis.
RTI active against HBV →Lamivudine
Least toxic nucleoside analogue →lamivudine
RTI associated with fatal hypersensitivity reactionAbacavir "
Side effects of Nevirapine →StevenJohnson syndrome, TEN, Hepatotoxicity
S IE of efavirenz - psychiatric (delusion, depression, euphoriA.
Class associated with lipodystrophy - Protease inhibitors
Class associated with risk of spontaneous bleeding Protease Inhibitors.
PI with max. CNS penetration - Indinavir
PI with max. drug interaction - Ritonavir.
S/e of Indinavr - Hyperbilirubinemia, Nephrolithiasis.
Best tolerated PI - Saquinavir.