Tardive Oromandibular Dystonia Induced by Trazodone: A Clinical Case and Management from the Perspective of the Dental Specialist

Abstract

Background: Tardive Oromandibular Dystonia is an iatrogenic drug-induced movement form of extrapyramidal symptoms associated primarily with chronic consumption of dopamine receptor blocking agents. Tardive symptoms attributable to selective serotonin reuptake inhibitors antidepressants are far less prevalent. Clinical Case: The authors will present a clinical case and management, from the dental specialist perspective, of a 55-year-old female patient who developed tardive oromandibular dystonia induced by Trazodone prescribed for sleep insomnia. Conclusions: Trazodone-induced oromandibular dystonia is extremely rare. Early identification and assessment of tardive symptoms are imperative for successful treatment. Trazodone should be prescribed with caution in patients taking other medications with the potential to cause tardive syndromes.

Putative Mechanism of Action of Trazodone-Related Oromandibular Dyskinesia

“…Its metabolite m-chlorophenylpiperazine (MCPP) has a ½ life of 4–14 hr with no significant affinity for dopaminergic receptors. However, MCPP is known to be a serotonin agonist specifically at the 5HT2C receptor that may have a releasing effect on oral-facial abnormal movements [ 11 ]. There are competing models suggesting that trazodone use could result in the development of OMD.…”

“…Additionally, the case that 5HT2A receptor polymorphisms determine susceptibility to dyskinesias/dystonias with antidepressants. It is unknown if this effect is more prominent in the older population [ 11 , 13 , 15 ]. In this case series two of the three patients were in their 60s which raises the question of whether older individuals who may be more prone to age-related dyskinesias may be more sensitive to the trazodone metabolite associated with hyperkinetic syndromes.…”