A case of relapsed tardive dyskinesia due to clozapine dose reduction

Uzun, Özcan; Cansever, Adnan; Özşahin, Aytekin

doi:10.1097/00004850-200111000-00009

Cited by 17 publications

(8 citation statements)

References 6 publications

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“…When 23 subjects in a 48-week double-blind dose-response study received clozapine at three doses, 100 mg/d, 300 mg/d, or 600 mg/d each for 16 weeks, improved TD as measured by the Abbreviated Dyskinesia Rating Scale (ADRS) presented in only those receiving a clozapine dose of 600 mg/d (Nair et al, 1998). This same finding has been corroborated in several case reports (Shrivastava et al, 2009; Uzun et al, 2001).…”

Section: Discussionsupporting

confidence: 82%

Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review

et al. 2019

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Background: It is commonly recommended that a switch to clozapine be implemented in the face of tardive dyskinesia, even if current treatment involves another “atypical” agent. However, reports do indicate clozapine carries a liability for tardive dyskinesia. Aims: This review sought to evaluate clozapine in relation to tardive dyskinesia in the context of available evidence. Methods: Medline, Embase, and PsycINFO databases were searched for studies published in English, using the keywords: clozapine AND tardive dyskinesia OR TD. References from major review articles were searched for additional relevant publications. Studies were included if they investigated: tardive dyskinesia in clozapine-treated patients diagnosed with schizophrenia spectrum disorders, and reported on two or more assessments of tardive dyskinesia severity measured by the Abnormal Involuntary Movement Scale; or clozapine’s tardive dyskinesia liability. Results: In total, 513 unique citations were identified and 29 reports met the inclusion criteria. Thirteen studies suggest clozapine reduces dyskinetic symptoms over time ( n=905 clozapine-treated participants); however, the minimum required dose and effect of withdrawal requires further investigation. The majority of reports which address clozapine’s liability for tardive dyskinesia are case studies (11 of 14 reports, 79%), and clozapine was only the first-line treatment in one of the remaining three studies reporting treatment-emergent dyskinetic symptoms with clozapine in 12% of patients. No significant between-drug differences were identified comparing clozapine’s risk to other atypical antipsychotics. Conclusions: Research to date supports switching to clozapine for the purpose of reducing tardive dyskinesia risk and/or treating existing tardive dyskinesia, but prospective randomized controlled trials are necessary if we are to substantiate existing recommendations.

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Section: Discussionsupporting

confidence: 82%

Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review

et al. 2019

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“…There are some case reports of relapse of TD symptoms after abrupt clozapine withdrawal, [9][10][11] indicating that clozapine might only suppress the symptoms. In this trial, the long-term exposure to the drug leads us to believe that clozapine, besides actively suppressing TD symptoms initially, might also diminish the supersensitivity of D 2 receptors in the striatum during the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Louzã

Bassitt²

2005

Journal of Clinical Psychopharmacology

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\Drug-induced tardive dyskinesia (TD) affects approximately 20% to 30% of schizophrenic patients. Although it is usually mild, from 1% to 8% of patients may develop severe TD. Second-generation antipsychotics have demonstrated a lower risk of inducing TD. However, despite the advances brought by second-generation antipsychotics, the treatment strategies for TD remain problematic, given both the lack of an established therapeutic choice and the need for long-term use of antipsychotics in the treatment of schizophrenia. Clozapine is an atypical antipsychotic with minimal risk of inducing TD. Furthermore, it has been suggested that clozapine might actually improve the symptoms of TD. Accordingly, we evaluated the effects of clozapine on severe TD over 5 years. Seven patients meeting Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for chronic exacerbated schizophrenia (mean age 28.5 +/- 10.2 years) and presenting severe TD, defined as Abnormal Involuntary Movements Scale score above 13, were treated with clozapine and followed up for 5 years. Extrapyramidal Symptoms Rating Scale assessment was performed in all patients at baseline, after 6 months and 3 and 5 years. Mean Extrapyramidal Symptoms Rating Scale scores decreased 83% after 3 years and 87.5% after 5 years. Mean dose for all patients was 428 +/- 269 mg/d after 5 years. Results from this open-label study suggest that clozapine may be a further option for the treatment of TD over long term.

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“…28 Klozapin ilginç şekilde mevcut geç diskinezi tedavisinde potansiyel etkiye sahiptir. 29,30 Tetrabenazin ve rezerpinin geç diskinezi ve geç distoni için en etkili ilaçlar olduğu gösterilmiştir. 29,31 Klonazepam ile naltrekson kombinasyonunun, muhtemelen beyin GABA ve bazal ganglionlar ensefalinerjik nöronlar üzerinde etkileşimin bir sonucu olarak, geç diskinezi iyileştirmede etkili olduğu bulunmuştur.…”

Section: Geç Di̇ski̇nezi̇unclassified

Antipsychotic-Induced Tardive Syndromes: Clinical Features and Treatment Approaches

Uzun¹,

Aylak²

2017

Turkiye Klinikleri J Med Sci

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A case of relapsed tardive dyskinesia due to clozapine dose reduction

Cited by 17 publications

References 6 publications

Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review

Clozapine and tardive dyskinesia in patients with schizophrenia: A systematic review

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Antipsychotic-Induced Tardive Syndromes: Clinical Features and Treatment Approaches

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