Fast Five Quiz: Movement Disorders

Helmi L. Lutsep, MD

Disclosures

July 08, 2021

Tardive dyskinesia can be caused by long-term treatment with dopamine antagonists. It can also be caused by both high-potency and low-potency traditional neuroleptics, including long-acting depot formulations (eg, decanoate and enanthate). Greater D2 dopamine receptor blockade at the trough levels of the neuroleptics may be associated with a greater degree of tardive dyskinesia. Amisulpride has been associated with tardive dyskinesia; in general, however, newer atypical antipsychotic agents, including olanzapine and risperidone (and its metabolite paliperidone), appear to carry less risk for tardive dyskinesia.

The antiemetic metoclopramide, a potent D2 dopamine receptor antagonist, may cause tardive dyskinesia, particularly in elderly patients. Tardive dyskinesia has also been reported with the use of antihistamines, fluoxetine, amoxapine (a tricyclic antidepressant), and other agents.

Table. Non-antipsychotic Medications Linked to Dyskinesias

Category Agents
Anticholinergics Benzhexol
Biperiden
Ethopropazine
Orphenadrine
Procyclidine
Antidepressants MAOIs: phenelzine
SSRIs: fluoxetine, sertraline
Trazodone
TCAs: amitriptyline, amitriptyline-perphenazine, amoxapine, doxepin, imipramine
Antiemetics Metoclopramide
Prochlorperazine
Antiepileptic drugs Carbamazepine
Ethosuximide
Phenobarbital
Phenytoin
Antihistamines Various
Antihistaminic decongestants Combinations of antihistamines and sympathomimetics
Antimalarials Chloroquine
Antiparkinson agents Bromocriptine
Carbidopa-levodopa
Levodopa
Anxiolytics Alprazolam
Biogenic amines Dopamine
Mood stabilizers Lithium
Oral contraceptives Estrogens
Stimulants Amphetamine
Methylphenidate
Caffeine
MAOI = monoamine oxidase inhibitor; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

Read more on the etiology of tardive dyskinesia.

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