Prophylactic Antiparkinson Drug Use: II. Withdrawal After Long‐Term Maintenance Therapy

Abstract

Although the efficacy of long-term neuroleptic treatment of schizophrenic patients is generally accepted, the use of concurrent antiparkinson drugs is less well defined. The value of prolonged antiparkinson drug use in preventing extrapyramidal side effects is controversial. More than 30 studies of antiparkinson drug withdrawal have attempted to answer this question. The authors reviewed all double-blind, placebo-controlled studies, and found most to contain serious methodologic or statistical flaws. There is evidence to support the long-term use of these agents in preventing extrapyramidal side effects. The authors offer an analysis of the benefits and risks that are involved with prophylactic antiparkinson drug use, and conclude that most patients would benefit from maintenance therapy.

Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia

“…ACM discontinuation and withdrawal studies found that 7-80% of chronic schizophrenia patients developed crippling EPS and needed the re-introduction of ACM (Lavin and Rifkin, 1991); some patients even experienced deterioration of their mental state (Drimer et al, 2004). In contrast, a double-blind, placebo-controlled study showed that ACM could be slowly and gradually withdrawn in approximately 90% of patients with chronic schizophrenia without noticeable worsening in their mental or motor status (Ungvari et al, 1999).…”

“…Carnahan et al (2006) concluded that 'the presence of an anti-extrapyramidal side effects (EPS) drug is a sign of a negative outcome, regardless of the reasoning behind its prescription'. In contrast, arguments have been put forward that the incidence of anticholinergic side effects is generally low, and at maintenance doses ACM could facilitate a better adherence to antipsychotics (AP) treatment (Gerlach et al, 1977;Goff et al, 1991;Lavin and Rifkin, 1991;Rifkin et al, 1978). ACM may partially ameliorate negative symptoms, although this finding needs replication (Tandon and Dequardo, 1995).…”

“…The necessity of long-term anticholinergic medication (ACM) for patients with chronic schizophrenia has long been a controversial issue (Carnahan et al, 2006;Lake et al, 1986;Lavin and Rifkin, 1991;Ungvari et al, 1999). ACM causes a variety of anticholinergic side effects, including the impairment of cognitive capacity (Brebion et al, 2004).…”

Trihexyphenidyl (Artane) Dependence: A Controlled Investigation between Users and Abusers

“…Those psychotic patients with risk factors (male sex, young and elderly patients and high potency antipsychotics), who continue to manifest extrapyramidal symptoms, reasonably need at least three months of anticholinergic treatment. 26 Subsequently, on follow-up visits, a trial of anticholinergic drug withdrawal would further guide whether or not to continue antiparkinson drugs 27 on a long-term basis. About 10% to 60% of patients develop extrapyramidal symptoms when anticholinergics are withdrawn.…”

Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009

“…The use of anticholinergic drugs (ACM) in the treatment of drug-induced extrapyramidal side effects (EPS) has been a controversial issue, particularly their continuous prescription in chronic schizophrenia [1][2][3]. Side effects related to ACM are cognitive impairment [4,5], the potential for abuse [6], central anticholinergic syndrome at higher doses [7], worsening of positive symptoms [8], and elevated risk for tardive dyskinesia (TD) [9].…”