Drug therapies for tardive dyskinesia: Part 1

Blocking dopamine (DA) receptors in the basal ganglia can cause parkinsonian symptoms, acute dystonia, akathisia, tardive dyskinesia (TD), and neuroleptic malignant syndrome. TD is characterized by abnormal, involuntary, irregular motor movements involving muscles of the head, limbs, or trunk. Many drug therapies have been tried for TD, but none are approved by the U.S. Food and Drug Administration. The second-generation antipsychotic drugs should be considered as a treatment of first choice for clinically significant TD, because they will also be potentially effective as a primary treatment for the underlying disorder. Dopamine-depleting drugs are effective for TD, but their practical use is severely limited because of tolerability and safety concerns. Various DA-modulating drugs have been tried; clinical evidence of efficacy suggests that amantadine (Symmetrel?) and naloxone (Narcan?) are worthwhile to try. Although efficacy evidence for buspirone (Buspar?) in TD is limited, this drug is safe and well tolerated and would be reasonable to try. Bromocriptine (Parlodel?), selegiline (Deprenyl?), and cholinergic-modulating drugs are not considered effective for TD.