Does anybody know whether oral proton pump inhibitors induce parkinsonism or not ? If so, what is the mechanism?
It is possible that in someone with mutations in the SLC2A9 gene could be susceptible to parkinsonism from low uric acid levels. PPIs can decrease uric acid and potentially further worsen the effect of the enzyme inhibition.
Parkinson's runs in my family and we do have low serum uric acid and an SLC2A9 mutation. Although I have not been diagnosed with Parkinson's, when I was put on a PPI during a hospital stay I developed tremors. They diminished after discontinuing the medication.
Here are some related links:
http://www.ncbi.nlm.nih.gov/pubmed/14571823
http://www.ncbi.nlm.nih.gov/pubmed/25288358
http://www.ncbi.nlm.nih.gov/pubmed/20589538
Dear Janet,
I highly appreciate your immediate response and detail information.
I am going to check the record of uric acid level before and after treatment with PPI.
Thank you so much.
Dead Yoshiyuki, the problem may be even more complicated. Message me privately if you like
From clinical experience, I was not aware of a relationship between PPI's and parkinsonism. Your question is very interesting espcially when a large number of patients with parkinsonsim are prescribed oral PPI's for reflux.
Dear Patricia,
Thank you for your comment.
Yes, a lot of Parkinson's disease patients are prescribed such medication.
So if PPI could induce or worsen parkinsonian symptoms, the problem is very complicated. In Japan, some herbal medicine can also be used for treatment of reflux.
I would face the question from another point of view.
The B12 deficiency is related with the development of many CNS symptoms which could mimick a parkinsonism.
The use of omeprazole, the first PPI, is a known risk factor of B12 deficiency, so, it could be interesting to know the actual symptoms (tremor, bradicinesia, rigidity, hypokinesia, etcétera). The determination of vitamin B12 and folic acid is included in the differential diagnosis during the first interviews in parkinsonism. In Parkinson disease, reflux, nausea and / or vomiting is treated more commonly with prokinetic drug as domperidone (although recently linked to problems of cardiac arrhythmia at extreme ages of life).
Manuel,
Thank you very much for your helpful comments. The patient showed progressive akinesia and rigity without tremor.
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