Clozapine and tardive movement disorders: A review

Valbenazine granted breakthrough drug status for treating tardive dyskinesia

“…Another practice is the switch to different drugs, for instance, use of atypical neuroleptics. Benzodiazepines, such as clonazepam; amantadine; levetiracetam; piracetam; propranolol; vitamin B6; ginkgo biloba; reserpine; anticholinergics and, in particular, tetrabenazine, may provide some symptomatic relief from tardive syndromes [1,6,[9][10][11].…”

“…Atypical neuroleptics, such as the dibenzazepines clozapine, olanzapine or quetiapine, show a reduced risk for onset of a tardive syndrome [1,6]. However, the atypical antipsychotic benzisoxazole derivatives, such as risperidone, have an elevated risk for onset of acute dystonia and tardive syndromes.…”

“…It responds to intravenous or oral application of anticholinergics. It is not proven that an elevated sensitivity for this drug-induced dystonia predisposes for the delayed occurrence of hyperkinetic movements, the so-called tardive syndrome [1,[5][6][7]. This term was first used in the early 1960s.…”

Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

“…20 The prognosis and outcomes are by and large poor with remission rates reported as low as 14%. The discontinuation of antipsychotics increases the chance of remission 4-fold but is usually not clinically feasible.…”

“…21 The rarity of TDt precludes large-scale, double-blind, placebo-controlled trials with sufficient sample size and adequate power. Treatments that have been tried to ameliorate symptoms of TDt include dopaminergic agents, 21 neuroleptic withdrawal, increase in neuroleptics, dopamine depletors, 22 reserpine, 23 anticholinergic medications, 24 GABAergic drugs, 25 botulism toxin, 26 α agonists, such as clonidine, 27 electroconvulsive therapy, 28 antispastic agents, 29 cerulitide, 30 calcium channel blockers, antioxidants, lithium, cholinergic agents, 31 carbamazepine, diphenhydramine, propranolol, neural growth factor, opiates, 32 acupuncture, 33 SGA agents including clozapine, 20 and deep brain stimulation. 34 This article reviews the current level of evidence demonstrating the clinical effectiveness (not efficacy) of SGAs in the treatment of TDt.…”