Clozapine-induced Tardive Dyskinesia

Das, Soumitra; Purushothaman, Sumesh Thoppil; Rajan, Varun; Chatterjee, Seshadri Sekhar; Kartha, Arjun

doi:10.4103/ijpsym.ijpsym_194_17

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…The exception is clozapine, the most atypical AAP (classified as an AAP even though it was already on the market in the 1960s); substantial evidence indicates it is almost free of extrapyramidal side effects, apart from akathisia. However, although the risk of TD is generally agreed to be lower with clozapine than with TAPs, evidence remains that even clozapine may cause new TD or intensify existing TD [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] (for review, see Hazari et al [38]). However, the decrease in TD prevalence rates with all other AAPs was much less than expected, and clinicians are cautioned not to overestimate the safety of AAPs [39].…”

Section: Introductionmentioning

confidence: 99%

Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies

2018

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All antipsychotics, including the atypical antipsychotics (AAPs), may cause tardive dyskinesia (TD), a potentially irreversible movement disorder, the pathophysiology of which is currently unknown. The prevention and treatment of TD remain major challenges for clinicians. We conducted a PubMed search to review the prevalence and etiology of and management strategies for TD associated with AAPs. TD prevalence rates varied substantially between studies, with an estimated prevalence of around 20% in patients using AAPs. The risk of TD is lower with AAPs than with typical antipsychotics (TAPs) but remains a problem because AAPs are increasingly being prescribed. Important risk factors associated with TD include the duration of antipsychotic use, age, and ethnicity other than Caucasian. Theories about the etiology of TD include supersensitivity of the dopamine receptors and oxidative stress, but other neurotransmitters and factors are probably involved. Studies concerning the management of TD have considerable methodological limitations. Thus, recommendations for the management of TD are based on a few trials and clinical experience, and no general guidelines for the management of TD can be established. The best management strategy remains prevention. Caution is required when prescribing antipsychotics, and regular screening is needed for early detection of TD. Other strategies may include reducing the AAP dosage, switching to clozapine, or administering vesicular monoamine transporter (VMAT)-2 inhibitors. In severe cases, local injections of botulinum toxin or deep brain stimulation may be considered. More clinical trials in larger samples are needed to gather valid information on the effect of interventions targeting TD.

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Section: Introductionmentioning

confidence: 99%

Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies

2018

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“…6,7 Some early reports indicated a potential for a switch to clozapine to treat TD because of its lower affinity for dopamine D 2 receptors, [8][9][10] but there is insufficient evidence to support this strategy 4,5 ; furthermore, cases of clozapine-induced TD have been reported. [11][12][13][14] Anticholinergic agents have also been used off-label for TD, but there is a lack of sufficient supportive evidence for efficacy, and they may exacerbate TD. 4,5,15,16 Valbenazine, a unique and highly selective vesicular monoamine transporter 2 (VMAT2) inhibitor, 17 was the first medication approved by the US Food and Drug Administration (FDA) for the treatment of TD and is now approved for use in Japan and several other countries in Asia.…”

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confidence: 99%

“…In addition, these approaches may not be clinically feasible in most patients whose psychiatric symptoms are well managed with their current treatment regimens and/or those at high risk of decompensation from changes in antipsychotic treatment 6,7 . Some early reports indicated a potential for a switch to clozapine to treat TD because of its lower affinity for dopamine D 2 receptors, 8–10 but there is insufficient evidence to support this strategy 4,5 ; furthermore, cases of clozapine-induced TD have been reported 11–14 . Anticholinergic agents have also been used off-label for TD, but there is a lack of sufficient supportive evidence for efficacy, and they may exacerbate TD 4,5,15,16 …”

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confidence: 99%

Sustained Treatment Response and Global Improvements With Long-term Valbenazine in Patients With Tardive Dyskinesia

Correll,

Citrome,

Singer

et al. 2024

J Clin Psychopharmacol

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Purpose/Background Using data from KINECT® 4, a phase 3, 48-week study of valbenazine, post hoc analyses were conducted to assess long-term outcomes that are relevant to the real-world management of tardive dyskinesia (TD). Methods/Procedures Post hoc analyses of the participants of the KINECT 4 study who completed 48 weeks of open-label valbenazine (40 or 80 mg) treatment were conducted. Valbenazine effects on TD were evaluated using the Abnormal Involuntary Movement Scale (AIMS), Clinical Global Impression of Change—TD (CGI-TD), and Patient Global Impression of Change (PGIC). Findings/Results Of 103 participants completing 48 weeks of treatment, 55% experienced clinically meaningful improvement (defined as ≥2-point reduction in AIMS total score [sum of items 1–7, evaluated by site raters]) by week 4; at week 48, 97% met this threshold. The percentage of completers who achieved AIMS total score response thresholds of ≥10% to ≥90% increased over time, with 86% of completers reaching ≥50% improvement. Of the 40 (39%) completers with AIMS ≥50% response at week 8, 38 (95%) sustained this response at week 48; 81% of those who did not meet this threshold at week 8 had achieved it by week 48. At week 48, more than 85% of completers achieved CGI-TD and PGIC ratings of “much improved” or “very much improved.” Implications/Conclusions The majority of participants who completed 48 weeks of treatment with once-daily valbenazine experienced substantial clinically meaningful and sustained TD improvements. These findings indicate that valbenazine can be a highly effective long-term treatment in patients with TD.

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“…Previously, cases of clozapine-associated Pisa syndrome have been reported. [5][6][7] Most patients receive 300-500 mg clozapine/d for 1.5 months to 10.5 years before suffering Pisa syndrome. 8 In this situation, clinicians must decide whether to discontinue clozapine to address TD symptoms.…”

mentioning

confidence: 99%

Clozapine-Induced Reversible Pisa Syndrome in a Patient With Delusional Parasitosis

Shen

Tzeng

Yeh

et al. 2021

American Journal of Therapeutics

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Clozapine-induced Tardive Dyskinesia

Cited by 5 publications

References 5 publications

Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies

Tardive Dyskinesia Associated with Atypical Antipsychotics: Prevalence, Mechanisms and Management Strategies

Sustained Treatment Response and Global Improvements With Long-term Valbenazine in Patients With Tardive Dyskinesia

Clozapine-Induced Reversible Pisa Syndrome in a Patient With Delusional Parasitosis

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