Expert: Ronald Levy, M.D. - 3/20/2010

Question
We attend a  P.D. group as my husband has this disease.   My gdmother, mother and uncle all had parkinsons and of course it worries me about my chances.  We had a speaker from Shands Hospital talking at our group and he said that if you are prone to getting P.D. and are given the wrong anti-nausea med at the end of surgery by the anesthesiologist that you will have P.D. immediately.  He said there are 2 only that should be used in this situation.  Could you tell me the exact names as I can only guess at the spelling  =  sopine? or tigrain?  Really not sure as the doctor had a very bad accent and we were in the back of the room and could not question him later.  He was from the Univ. of Fla. Movement disorders clinic and was responding to a patient that said he never had P.D. until he had shoulder surgery.  My concern is I have to have hip replacement surgery the beginning of May.   Can you help me with these drug names?  Thank you for your time.

Answer
There is no anti-nausea drug that causes PD. Whoever told you that doesn't understand anything. PD is caused by a depletion of Dopamine and PD medications increase the dopamine (or work on the Dopamine receptors) to minimize the effects. There are several anti-nausea drugs (metoclopramide (Reglan), promethazine (Phenergan) and prochlorperazine (Compazine)) that work by blocking the Dopamine receptor. So in effect, they are blocking the effect of the PD medication. So these drugs can worsen (temporarily) the effects of PD that someone already has. It will not cause PD. The most common drug we use in the OR is Ondansatron (Zofran) which works by a different pathway and has no effect on PD. Tigan (trimethobenzamide) is another antiemetic but I have no experience with this medicine so I can't tell you it's effect. I don't know the other drug you refer to.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston