Drug-induced paresthesias (DIP) are abnormal sensory phenomena usually experienced by patients in the limbs, especially distally, and are described as numbness or tingling, "pins and needles," burning, or even itching. Paresthesias that are very bothersome or painful are sometimes referred to as dysesthesias. Paresthesias can be spontaneous (the most common occurrence with DIP), but they may also be evoked with external stimuli.

DIP can be an acute reaction to medications or a result of a drug-induced neuropathy. Symptoms may be related to peak dose effect or cumulative dose. These can occur at any age, although the elderly are at increased risk for illnesses that are associated with peripheral neuropathy. Preexisting or subclinical peripheral neuropathy may predispose patients to more severe DIP.

There are many medications that can cause DIP; with any new onset of paresthesias after initiation of a medication, DIP should be considered.

Acute, nonpathological DIP can be seen with carbonic anhydrase inhibitors, including acetazolamide, topiramate, and zonisamide, because of electrolyte shifts at nerve membranes. DIP may be dose related and result from too-rapid titration.

Many chemotherapeutic agents are associated with DIP, usually cumulative dose dependent, and may be a dose-limiting factor; these include vinca alkaloids, taxanes, thalidomide, and platin agents. The latter causes symptoms by damaging the sensory ganglion as opposed to the distal axon and this is more likely to be permanent.