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drug-induced parkinsonism

Etiology: 1) drugs likely to induce parkinsonism a) neuroleptics with little or no anticholinergic activity - haloperidol (Haldol) - fluphenazine (Prolixin) - thiothixene - chlorpramazine - perphenazine - loxapine - pimozide - trifluoperazine b) atypical antipsychotics - aripiprazole (Abilify) - olanzapine (Zyprexa) - paliperidone (Invega) - risperidone (Risperdal) - ziprasidone (Geodon, Zeldox) c) antiemetics - prochlorperazine (Compazine) - metoclopramide (Reglan) d) antihypertensives - reserpine - alpha-methyldopa (rare) e) tetrabenazine [4] 2) less commonly implicated drugs - lithium carbonate (rare) - clozapine (Clozaril) less commonly - quetiapine (Seroquel) less commonly - SSRI - citalopram (Celexa) - fluoxetine (Prozac) - praxoetine (Paxil) - sertraline (Zoloft) - valproate (Depakene, Depakote) - amiodarone [4] - flunarizine [4] Epidemiology: 1) more common in women 2) more common in the elderly Clinical manifestations: 1) signs generally develop within 3 months of starting offending agent 2) may persist for several months after discontinuing offending agent 3) tremor less common than Parkinson's disease 4) bradykinesia is generally symmetric 5) absence of typical nonmotor features of Parkinson's disease 6) may not be distinguishable from Parkinson's disease Management: 1) discontinue offending agent if possible - symptoms may persist for up to 6 months [4] 2) substituting antipsychotic for one with more anticholinergic activity 3) substitute antipsychotic with lamotrigine [5] 4) trihexyphenidyl (Artane) 5) amantadine, start 100 mg BID [2] 6) L-dopa is of no value if the offending neuroleptic is continued & may worsen underlying psychotic disorder

Related

anti-emetic antipsychotic agent bradykinesia fluphenazine (Prolixin, Anatensol, Triflumethazine, Calmansial, Modecate) haloperidol (Haldol, Halperon, Aloperidol, Halomonth) levodopa; L-3-hydroxytyrosine; L-3,4-dihydroxyphenylalanine; L-dopa (Dopar, Larodopa, Inbrija) lithium carbonate (Eskalith, Lithane, Lithobid, Lithonate) methyldopa (Aldomet) metoclopramide (Reglan, Metozolv ODT) neuroleptic Parkinson's disease (paralysis agitans, PD) prochlorperazine (Compazine, Stemetil, Novamin, Buccastem) reserpine (Serpasil, Apoplon) thiothixene (Navane, Tiotixene) trihexyphenidyl (Artane, Trihexy)

General

parkinsonism drug-induced movement disorder

References

  1. Harrison's Online, McGraw-Hill, 2002
  2. Zoe Martinez MD, UCLA Dept of Psychiatry
  3. Prescriber's Letter 17(12): 2010 Drug-Induced Parkinsonism Detail-Document#: 261211 (subscription needed) http://www.prescribersletter.com
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. NEKM Knowledge+ Neurology