Re: Effects of stomach acid inhibitors on PN

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Posted by CCF NEURO MD on June 09, 1997 at 10:59:36:

In Reply to: Effects of stomach acid inhibitors on PN posted by Ron Galwey on June 01, 1997 at 15:29:36:

: I heard a radio doctor mention that stomach acid inhibitors like Zantac, Pepcid and Prilosec used for prolonged periods could cause vitamin B12 to not be absorbed properly thus leading to PN. Is this true? I’ve been using most of these drugs for years and have been diagnosed with sensory PN in the last year. Could the inhibitors be the cause? If so, what does one do? Besides stop taking the drugs.

Thanks

Ron

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While there are a number of medications that cause peripheral neuropathy, pecid is not generally
thought to be a cause of neuropathy. However in the physician desk reference manual, it does list
paresthesias (tinglig/pin ***** like sensations). Vitamin B12 is a common cause of peripheral
neuropathy and should be checked in all patients with symptoms/signs of a peripheral neuropathy. Gastric acid inhibitory drugs (histamine H2-receptor blockers)have been studied for their long term effects. There are reports that the adverse reactions are low. The risk is related to prolonged acid suppresion which allows the growth of normal microorganisms in the gut, but this is at higher doses than are generally used. Pernicious anemia is a cause of vitamin B12 deficiency and is associated with lack of acid production.
However if the low acid levels in the stomach are associated with decreased absorption of Vitamin B12, one should see low levels on serum laboratory tests. One may also test homocysteine and methylmalonic acid which are dependent on B12, and will levels be found to be high in vitamin B12 deficiency. If the levels are normal there is no reason to discontinue the medication.
If you feel that it is the cause of your neuropathy, then it may be worth asking your physician if there is
an alterative or if you could discontinue it (This depends on why you aretaking it). You should
have a neurologic evaluation to determine the extent of the neuropathy and to assess for other
treatable causes such as diabetes, thyroid disease, vit B12 deficiency or vasculitis. However, even
after extensive evaluation, a subset of patients may still not have an etiology for their neuropathy. If
you would like to be assessed at the Cleveland Clinic's Neuromuscular Clinic Neuromuscular department, call
216-444-5559 or 1-800-223-2273 ext 45559 to arrange an appointment.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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