Chemotherapy-induced Peripheral Neuropathy
Supplements studied for chemotherapy-induced peripheral neuropathy.
Overview
Chemotherapy-induced peripheral neuropathy has the most data for Vitamin E (seven studies), Alpha-Lipoic Acid (four), and smaller trials of Acetyl-L-Carnitine, N-Acetyl Cysteine (NAC), and Milk Thistle. Vitamin E does not consistently prevent neuropathy overall, though weak signals exist for specific platinum regimens.
Alpha-Lipoic Acid results vary by chemotherapy agent: no benefit during cisplatin or oxaliplatin in one trial, but reduced severity with paclitaxel in another. Acetyl-L-Carnitine may worsen neuropathy in one study. NAC and Milk Thistle evidence is limited or inconclusive. See the heatmap and evidence reviews below.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| Vitamin E | ★★★★★ | Low |
| Alpha-Lipoic Acid | ★★★★★ | Low |
| N-Acetyl Cysteine (NAC) | ★★★★★ | Low |
| Milk Thistle | ★★★★★ | Low |
| Acetyl-L-Carnitine | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
5 supplements for and rated at least stars. All purchase bands. No minimum star filter.
Vitamin EView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Taking vitamin E by mouth does not seem to help prevent nerve damage caused by chemotherapy (chemotherapy-induced peripheral neuropathy).
- Some small studies suggest that taking 600 mg daily for 3 months might help prevent nerve problems from certain chemotherapy drugs like cisplatin, carboplatin, or oxaliplatin, but the evidence is weak and not consistent.
- Vitamin E does not help in nerve damage caused by other chemotherapy medicines such as paclitaxel.
- A large high-quality study showed that 400 mg of vitamin E daily does not prevent nerve damage.
- Expert guidelines do not recommend using vitamin E for this purpose.
Browse 7 studies·3 meta-analyses
MetaProtective Effects of Vitamin E on Chemotherapy-Induced Peripheral Neuropathy: A Meta-Analysis of Randomized Controlled Trials2021n=488
In a meta-analysis of 488 participants, 600 mg/day, moreover, vitamin E supplementation significantly decreased patients' sural amplitude after 3 rounds of chemotherapy (RR -2.66; 95% CI -5.09 to -0.24; p = 0.03) in contrast with that of placebo supplementation, while no significant difference was observed when patients were treated...
- Effect
- Benefit
- Dose
- 600 mg/day
- Population
- Cancer patients
- Participants
- 488
RCTVitamin E does not decrease the incidence of chemotherapy-induced peripheral neuropathy: a meta-analysis2016n=353
In an RCT of 353 participants, the results showed that vitamin E supplementation did not appear to significantly decrease the incidence of CIPN (relative risk (RR), 0.55; 95% confidence interval (CI), 0.29 to 1.05; p = 0.07), with significant heterogeneity (I(2) = 77%).
- Effect
- No Benefit
- Population
- Cancer patients
- Participants
- 353
GuidePrevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO clinical practice guideline2014
MetaProtective effects of vitamin E on chemotherapy-induced peripheral neuropathy: a meta-analysis of randomized controlled trials2013n=319
In a meta-analysis of 319 participants, 600 mg/day, the relative risk (RR) of CIPN with vitamin E supplementation, compared with placebo, was assessed with the Bayesian random effect model and expressed as RR with a 95 % credible-interval (CrI).
- Effect
- Benefit
- Dose
- 600 mg/day
- Population
- Cancer patients
- Participants
- 319
RCTThe use of vitamin E for the prevention of chemotherapy-induced peripheral neuropathy: results of a randomized phase III clinical trial2011n=100
In an RCT of 100 participants, 400 mg, there were no significant differences between treatment arms for time to onset of neuropathy (P = 0.58), for chemotherapy dose reductions due to neuropathy (P = 0.21), or for secondary endpoints derived from patient-reported neuropathy symptom assessments.
- Effect
- No Benefit
- Dose
- 400 mg
- Population
- Cancer patients
- Participants
- 100
RCTA randomized controlled trial evaluating the efficacy and safety of vitamin E supplementation for protection against cisplatin-induced peripheral neuropathy: final results2006n=16
In an RCT of 16 participants, 600 mg/day, the relative risk (RR) of developing neurotoxicity was significantly higher in case of controls, RR=2.51, 95% C.I.=1.16-5.47.
- Effect
- Benefit
- Dose
- 600 mg/day
- Population
- Cancer patients
- Participants
- 16
RCTNeuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy2003n=47
In an RCT of 47 participants, 300 mg/day, for 3 months, supplementation of patients receiving cisplatin chemotherapy with vitamin E decreases the incidence and severity of peripheral neurotoxicity.
- Effect
- Benefit
- Duration
- 3 months
- Dose
- 300 mg/day
- Population
- Cancer patients
- Participants
- 47
Alpha-Lipoic AcidView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Research on alpha-lipoic acid for preventing nerve damage caused by chemotherapy shows mixed results.
- In one study, people taking 600 mg three times a day for 24 weeks during cisplatin or oxaliplatin treatment did not notice any difference in symptoms compared with those taking a placebo.
- Another smaller study in breast cancer patients receiving paclitaxel found that taking 600 mg daily for six months lowered the severity of nerve symptoms.
- These differences might be due to the type of chemotherapy used.
- Alpha-lipoic acid has also been tested in combination products.
- A supplement containing alpha-lipoic acid (240 mg), MSM (200 mg), Boswellia (40 mg), and bromelain (20 mg) taken daily for 12 weeks reduced pain from chemotherapy-related nerve damage, though the study did not include a comparison group.
- Another small study using alpha-lipoic acid 600 mg daily with another compound, ipidacrine, during six chemotherapy cycles showed improvements in nerve function compared with a control group.
- It is unclear whether this effect came from alpha-lipoic acid, the other compounds, or both.
Browse 4 studies
RCTEFFECTIVENESS OF ALPHA-LIPOIC ACID AND IPIDACRINE HYDROCHLORIDE IN PREVENTION OF PACLITAXEL-INDUCED PERIPHERAL NEUROPATHY ASSESSED BY ELECTRONEUROMYOGRAPHY OF SUPERFICIAL PERONEAL AND SURAL NERVES2022n=50
RCT in 100 breast cancer patients on paclitaxel found ALA plus ipidacrine preserved sensory nerve action potential amplitudes better after 3 and 6 chemotherapy cycles.
- Effect
- Benefit
- Population
- Patients with peripheral neuropathy
- Participants
- 50
RCTRole of alpha-lipoic acid in counteracting paclitaxel- and doxorubicin-induced toxicities: a randomized controlled trial in breast cancer patients2022n=32
6-month RCT in 64 breast cancer patients given 600 mg/day ALA found less paclitaxel neuropathy and lower BNP, TNF-alpha, and MDA versus placebo during chemotherapy.
- Effect
- Benefit
- Duration
- 6 months
- Dose
- 600 mg/day
- Population
- Women
- Participants
- 32
Clinical trialUse of an alpha lipoic, methylsulfonylmethane and bromelain dietary supplement (Opera®) for chemotherapy-induced peripheral neuropathy management, a prospective study2017n=25
Prospective study of 25 chemotherapy-induced peripheral neuropathy patients on Opera supplement including ALA reported reduced pain and neuropathy scores, though RCT confirmation is needed.
- Effect
- Benefit
- Duration
- 12 weeks
- Population
- Chemotherapy-induced peripheral neuropathy patients
- Participants
- 25
RCTOral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial2014
24-week RCT of oral ALA at 600 mg three times daily during platinum chemotherapy found no significant neuropathy prevention versus placebo, with high dropout.
- Effect
- No Benefit
- Duration
- 24 weeks
- Dose
- 600 mg 3×/day
- Population
- Cancer patients
Milk ThistleView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is not clear if milk thistle helps with nerve damage caused by chemotherapy.
- In one small study, people taking a specific milk thistle product (140 mg three times daily) for three months during cisplatin treatment reported some improvement in symptoms compared to before treatment.
- However, compared to those taking a placebo, there was no clear benefit, except that some sensations like numbness and tingling did not get worse in the milk thistle group but did worsen in the placebo group.
Browse 1 study
RCTEffect of Silybum Marianum on Reduction of Chemotherapy-Induced Peripheral Neurotoxicity with Cisplatin2024n=60
An RCT of 60 cisplatin-treated cancer patients found Silybum marianum reduced chemotherapy-induced peripheral neuropathy scores on CIPNAT while placebo patients worsened.
- Effect
- Benefit
- Population
- Cancer patients receiving cisplatin
- Participants
- 60
N-Acetyl Cysteine (NAC)View supplement →
Reconsider purchase·★★★★★
How we scored this▸
- There is not enough evidence to determine if N-acetyl cysteine has any benefit for chemotherapy-induced peripheral neuropathy.
Browse 2 studies
RCTProtective effect of N-acetylcysteine on oxaliplatin-induced neurotoxicity in patients with colorectal and gastric cancers: A randomized, double blind, placebo-controlled, clinical trial2020
An RCT found 1200 mg/day NAC reduced oxaliplatin-induced peripheral neuropathy severity versus standard care in colorectal cancer patients.
- Effect
- Benefit
- Dose
- 1200 mg/day
- Population
- Cancer patients
RCTN-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data2006
An RCT found NAC (1200 mg/day) had neuroprotective effects against oxaliplatin-induced neuropathy during adjuvant chemotherapy.
- Effect
- Benefit
- Dose
- 1200 mg/day
- Population
- Cancer patients
Acetyl-L-CarnitineView supplement →
Do not purchase·★★★★★
How we scored this▸
- Taking acetyl-L-carnitine by mouth may worsen nerve damage caused by chemotherapy in cancer patients.
Browse 1 study
RCTRandomized double-blind placebo-controlled trial of acetyl-L-carnitine for the prevention of taxane-induced neuropathy in women undergoing adjuvant breast cancer therapy2013n=409
A 24-week randomized double-blind trial in 409 women undergoing adjuvant taxane-based chemotherapy compared acetyl-L-carnitine (3,000 mg/day) with placebo. There was no evidence that ALC prevented chemotherapy-induced peripheral neuropathy at 12 weeks; by 24 weeks, ALC significantly increased CIPN (scores 1.8 points lower with ALC). Patients receiving ALC were more likely to have a >5-point decrease in neurotoxicity scores (38% vs 28%), and grade 3–4 neurotoxicity was more frequent in the ALC arm (8 vs 1). The authors concluded that ALC increased CIPN and that patients should be discouraged from using supplements without proven efficacy.
- Effect
- No Benefit
- Duration
- 24 weeks
- Dose
- 3000 mg/day
- Population
- Women
- Participants
- 409
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| Vitamin E | ★★★★★52% | 7 | 3 | 47% |
| Alpha-Lipoic Acid | ★★★★★48% | 4 | 0 | 27% |
| N-Acetyl Cysteine (NAC) | ★★★★★44% | 2 | 0 | 13% |
| Acetyl-L-Carnitine | ★★★★★32% | 1 | 0 | 7% |
| Milk Thistle | ★★★★★44% | 1 | 0 | 7% |