Toxicity rises sharply with CYP3A4 or P-gp inhibitors
Disrupted axonal transport → peripheral neuropathy
Drugs with this mechanism (3)
Colchicine — Anti-inflammatory for gout and pericarditis; microtubule inhibitor, narrow index.
Tirbanibulin — Short-course topical treatment for actinic keratoses on the face or scalp; disrupts microtubules and commonly causes local inflammation.
Vincristine — Vinca-alkaloid chemotherapy; dose-limiting peripheral neuropathy, fatal if intrathecal.
Self-check
Which cell-trafficking effect explains anti-inflammatory activity? Impaired neutrophil trafficking.
Why can tubulin disruption cause peripheral neuropathy? Disrupted axonal transport.