Medications That Can Cause Tardive Dyskinesia

Tardive Dyskinesia - The Medications That Can Cause Involuntary Jaw Movements

Tardive dyskinesia is a concerning potential side effect of certain psychiatric and gastrointestinal medications. It causes uncontrollable movements of the face, mouth, and jaw. Understanding the causes, symptoms, diagnosis, and treatments for tardive dyskinesia can help manage this difficult condition.

What is Tardive Dyskinesia?

Tardive dyskinesia is a neurological movement disorder characterized by involuntary and repetitive movements. It typically affects the facial muscles, tongue, lips, and jaw. Chewing motions, tongue protrusion, lip smacking, grimacing, and blinking are common manifestations.

“Tardive” refers to the delayed onset of symptoms, which usually develop after months or years of using certain medications. “Dyskinesia” means abnormal or impaired movement.

Tardive dyskinesia is most commonly caused by antipsychotic drugs used to treat mental health conditions like schizophrenia and bipolar disorder. First generation antipsychotics pose the greatest risk.

Medications That Can Cause Tardive Dyskinesia

The classes of medications most frequently associated with tardive dyskinesia include:

• First generation antipsychotics - Haloperidol (Haldol), fluphenazine (Prolixin), perphenazine (Trilafon)
• Second generation antipsychotics - Risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa)
• Antiemetics - Metoclopramide (Reglan), prochlorperazine (Compazine)
• Antidepressants - Amitriptyline, imipramine, nortriptyline
• Mood stabilizers - Lithium

Antipsychotic drugs block dopamine receptors, which can impair motor control over time and trigger involuntary movements. The longer someone takes these medications, the higher their risk for developing tardive dyskinesia.

Who is at Risk for Tardive Dyskinesia?

Factors that increase the likelihood of developing tardive dyskinesia include:

• Older age
• Taking antipsychotic medications for prolonged periods
• High doses of antipsychotic medications
• Previous diagnosis of mood disorder
• Diabetes
• Alcohol abuse

Women and older adults are at heightened risk. Genetic factors that reduce dopamine activity may also make some individuals more vulnerable to tardive dyskinesia.

Symptoms of Tardive Dyskinesia

The involuntary movements caused by tardive dyskinesia most often affect the:

• Lower face - lip smacking, puckering, or chewing motions
• Jaw - repetitive side-to-side or up-and-down movements
• Tongue - darting, wiggling, or protrusion
• Extremities - repetitive finger movements or toe curling

Symptoms typically develop gradually over weeks or months. They are usually intermittent at first but can become permanent without proper treatment. The abnormal movements can range from mild to severe and can impact speech, eating, swallowing, and dental health.

Getting a Tardive Dyskinesia Diagnosis

To diagnose tardive dyskinesia, a doctor will:

• Review medical history, including current medications
• Conduct a physical exam to observe involuntary movements
• Rule out other potential neurological causes

There are no lab tests to diagnose tardive dyskinesia. However, blood tests may help determine whether current medications are at therapeutic levels.

Doctors may refer patients to neurologists who specialize in movement disorders for confirmation of tardive dyskinesia diagnosis and management.

Tardive Dyskinesia Treatment Options

Discontinuing the offending medication is the first step in treating tardive dyskinesia. However, this is often not possible for psychiatric medications needed to manage underlying mental health conditions.

Other tardive dyskinesia treatment approaches include:

• Reducing antipsychotic dose - Lowest effective dose decreases risk.
• Switching medications - Change to an atypical antipsychotic with lower risk.
• Adding on medications - Clonazepam, ginkgo biloba, tetrabenazine can help reduce symptoms.
• Facial muscle exercises - For mild cases, exercises may help retrain control.

In severe, persistent cases unresponsive to medication adjustments, surgical procedures are sometimes recommended, including:

• Deep brain stimulation
• Oral facial sensorimotor operant learning

However, results of tardive dyskinesia surgery are mixed, and risks include brain bleeding and stroke.

Lifestyle Changes to Manage Tardive Dyskinesia

Non-medical strategies can also minimize the impact of tardive dyskinesia symptoms:

• Stress management - Relaxation techniques help reduce symptom exacerbation.
• Avoid caffeine - Caffeine can worsen involuntary movements.
• Good sleep habits - Fatigue aggravates symptoms.
• Soft foods - Promote safety with swallowing and chewing issues.
• Oral hygiene - Prevent dental complications; gum shields protect from jaw clenching.

Joining a tardive dyskinesia support group can help patients feel less socially isolated.

Can Tardive Dyskinesia Be Prevented?

Strategies to help prevent tardive dyskinesia include:

• Choosing atypical antipsychotics first
• Using lowest effective medication doses
• Avoiding combinations of medications that increase risk
• Periodically stopping medication under medical supervision to check for involuntary movements
• Opting for psychotherapy instead of medication when possible

Educating patients on the early signs of tardive dyskinesia is key, as early intervention improves outcomes. Close monitoring and follow-up care are essential for at-risk individuals on long-term antipsychotic medications.

Tardive Dyskinesia Requires Careful Management

Tardive dyskinesia is a serious medication side effect requiring diligent monitoring, early diagnosis, and thoughtful treatment. Balancing psychiatric medication benefits with risks of tardive dyskinesia presents challenges for clinicians and patients.

Careful prescribing, dose optimization, vigilant screening for symptoms, and prompt intervention when needed are critical to improving tardive dyskinesia outlook and quality of life.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.