Rabeprazole and psychiatric symptoms.
OBJECTIVE
To report the case of a patient who developed marked anxiety associated with episodes of panic attacks after starting rabeprazole therapy.


METHODS
An otherwise healthy 55-year-old woman was prescribed rabeprazole 20 mg/day administered in the morning for persistent symptoms of dyspepsia. Ten days later, she presented with a 7 day history of marked anxiety associated with panic attacks, night terror (pavor nocturnus), episodic mental confusion, and attention deficit. Within 2 days of discontinuing rabeprazole, the patient recovered completely from the neuropsychiatric manifestations. Subsequent esomeprazole therapy did not cause psychiatric symptoms.


CONCLUSIONS
Rabeprazole-induced hypergastrinemia may have played a role in this neuropsychiatric adverse reaction. Several lines of evidence have indicated that gastrin-releasing peptide, whose release is mediated by proton pump inhibitor (PPI)-induced secretion of gastrin, is involved in regulating aspects of behavior that might be altered in disorders such as anxiety, depression, and dementia. The fact that rabeprazole has the highest capacity of inducing gastrin increase compared with other PPIs might explain why our patient's panic symptoms disappeared after switching to esomeprazole. Based on the Naranjo probability scale, rabeprazole was the probable cause of the adverse reaction.


CONCLUSIONS
Specific studies are needed to investigate the potential role of PPI-induced hypergastrinemia in neuropsychiatric adverse reactions.
Polimeni
Giovanni
G
Istituto di Ricovero e Cura a Carattere Scientifico Centro Neurolesi Bonino-Pulejo, Messina, Italy. gpolimeni@unime.it
Cutroneo
Paola
P
Gallo
Adele
A
Gallo
Salvatore
S
Spina
Edoardo
E
Caputi
Achille P
AP
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000009:adverse effects*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000139:chemically induced* / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D064750:Rabeprazole
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D064750:Rabeprazole