Healthfacts - Drug side effect mistaken for Parkinson’s disease - Reglan - adapted from the Journal of the American Medical Association, December 13, 1995
A physician mistakes a drug side effect for a disease, prescribes another drug, and more side effects occur. The scenario is probably common but not a path of inquiry many researchers are likely to pursue. Jerry Avorn, M.D. and colleagues at the Harvard Medical School, are the exception. They found that elderly people prescribed Reglan for gastroesophageal reflux (chronic heartburn) had a high likelihood of subsequently being misdiagnosed with Parkinson’s disease (JAMA, 13 December 1995). Reglan’s side effects can include Parkinson-like symptoms, such as difficulty speaking or swallowing, trembling, loss of balance, mask-like face, muscle spasm, limb stiffness, and unusual twisting movements of body.
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The Harvard team searched the Medicaid claims files (1981 to 1990) of people 65 years and older, nearly 19,000 in all. New prescriptions for antiparkinsonian drugs had been filled by about 3,000 people. Working backward from these new prescriptions, the researchers singled the people who were on Reglan. Here’s what they found: Within 90 days of a new prescription, people on Reglan were three times more likely to be started on a drug for Parkinson’s disease than people not taking Reglan.
Dr. Avorn and colleagues have an excellent record in documenting prescription drug abuses in the elderly (see HealthFacts, September 1994), and have written extensively about how elderly people metabolize drugs differently. Medical reference books, they note, state that the incidence of parkinsonian symptoms following a course of Reglan is rare; yet this may not apply to elderly people because they are underrepresented in premarketing clinical trials of drugs. It is well known that the frequency and intensity of adverse drug reactions may be substantially greater than in younger people. In fact, Dr. Avorn and colleagues wrote, Older people are more likely to have their drug-induced symptoms misinterpreted.
Reglan is a drug that was first introduced to prevent the nausea and vomiting caused by cancer chemotherapy. Later its use was expanded to include the alleviation of symptoms due to gastroesophageal reflux, which is the backward flow of stomach contents into the esophagus. Symptoms include heartburn and nausea. Reglan is listed as having limited use for people over age 60 in Worst Pills, Best Pills II: The Older Adult’s Guide to Avoiding Drug-Induced Death or Illness by Public Citizen’s Sidney M. Wolfe, M.D., and Rose-Ellen Hope, R.Ph. Before resorting to Reglan, the book advises first trying several dietary changes, such as eating small frequent meals so the stomach is never empty.
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