Minimize exposure to antidopaminergic drugs whenever possible to reduce the risk of drug-induced parkinsonism and tardive dyskinesia

Writers, Adis Medical

doi:10.1007/s40267-019-00642-8

Cited by 1 publication

(6 citation statements)

References 39 publications

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“…22 selected items could not be obtained as full-text. Additional papers (33) were sourced after revising the selected articles' reference lists. A total of 122 articles were included in the final review.…”

Section: Results With Discussionmentioning

confidence: 99%

“…Most studies report that increasing age (for both sexes) and female gender are more frequently associated with incidence and prevalence of DIP [8][9][10]14,16,17,23,[25][26][27][28]31,33]. However, the vast majority of these studies include all drug groups associated with DIP, hence it is difficult to ascertain the precise prevalence and incidence of AIP.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…In addition to age over 60 and female gender, a number of studies have suggested that other patient and drug-related factors can be associated with an increased risk of developing AIP (Table 4). Patient-related factors are organic brain damage, learning disability, dementia, IPD, hypertension, organic personality disorder, schizophrenia, mania, depression or anxiety, HIV infection, non-European ancestry, and presence of HLA-B44 [3,31,33,[47][48][49]; whilst drug-related causes are high potency APs, higher dosage of APs, and long-term exposure to APs [3,33]. The diagnosis of DIP has also been reported to triple the lifetime risk of developing IPD [50,51], whilst the relative risk of developing IPD was found in one study to be of 24.3 (CI 95%) [52].…”

Section: Risk Factorsmentioning

confidence: 99%

“…This is the mode of action of high-potency FGAs, due to their high antagonistic affinity for D2Rs in the striatum (e.g., the butyrophenone haloperidol). However, the pathophysiology of AIP is yet to be fully understood [33]. Dopamine blockade by itself does not account for AIP completely, as symptoms of parkinsonism may last for weeks to months, whereas its effects on psychotic symptoms only last for several hours [8,53].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Drugs that block D2Rs may also have a direct neurotoxic effect on dopaminergic neurons, and this may also explain why some patients continue to experience parkinsonism many months following discontinuation of the offending drug (around 20% of patients) [8,33,63]. This neurotoxic hypothesis is further supported by the finding of an increased long-term risk of developing IPD in older patients with a past history of exposure to APs [50], and by the findings in animal models of neuronal death with exposure to APs, likely via inhibition of the mitochondrial respiratory chain, increased D2R turnover, and free radical production [8,63].…”

Section: Pathophysiologymentioning

confidence: 99%

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Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

Wisidagama

Selladurai

et al. 2021

Medicines

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Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment.

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Section: Results With Discussionmentioning

confidence: 99%