What Diabetic Medication Can Cause Tardive Dyskinesia

What Type Of Doctors To See

In most cases, tardive dyskinesia occurs in mental health patients taking antipsychotic medications for conditions such as schizophrenia and bipolar disorder. With this being the case, the primary doctor to see for tardive dyskinesia is a psychiatrist. They will usually have been the prescribing doctor, and with regular appointments, they can monitor you for signs of involuntary movement. If you do exhibit tardive dyskinesia symptoms, they can also help you change or adjust medications accordingly. They may refer you to a neurologist who specializes in movement disorders. Seeing either your psychiatrist or another mental health professional for talk therapy can also be beneficial.

As with any condition, keeping your primary care doctor in the loop is crucial, so they can provide you with the best care possible and avoid prescribing a medication to you that might interact with something else you are taking or that may exacerbate symptoms.

Schizophrenia Drugs May Raise Diabetes Risk Study Says

By Erica Goode

Three drugs commonly prescribed for schizophrenia and other psychotic illnesses increased patients’ risk of developing diabetes when compared with older antipsychotic medications, researchers said yesterday, presenting the results from a long-awaited study of patients treated at veterans hospitals and clinics across the country.

The drugs — Zyprexa, made by Eli Lilly, Risperdal, made by Jannsen Pharmaceutica, and Seroquel, made by AstraZeneca — were associated with higher rates of diabetes than older generation drugs for schizophrenia like Haldol, the study found. But the increased risk was statistically significant only for Zyprexa and Risperdal, the researchers said, possibly because of the smaller number of subjects who took Seroquel.

Younger patients, under age 54, who took Zyprexa or Risperdal showed the highest risk of developing diabetes, the study, led by Francesca Cunningham of the Department of Veterans Affairs at the University of Illinois at Chicago, found.

The results add to a growing number of reports linking Type 2 diabetes to some drugs in the class of antipsychotics known as atypicals.

”These findings are absolutely consistent with everything we’ve looked at and seen,” said Robert Rosenheck, a professor of psychiatry and public health at Yale and an author of an earlier study that found an increased risk of diabetes with Zyprexa, Risperdal, Seroquel and Clozaril, made by Novartis.

Causes Of Tardive Dyskinesia

The primary cause of Tardive Dyskinesia is prolonged or chronic use of neuroleptic drugs that are prescribed for psychiatric conditions. Sometimes they can also be prescribed for neurological problems. Infants and children can develop this condition as a side effect of medicines used for treating gastrointestinal problems. Neuroleptic drugs act by blocking the receptors of the body for dopamine; which is a neurotransmitter associated with controlling the brains pleasure centers. Dopamine also plays role in the motor function of the body. The exact mechanism of how or why tardive dyskinesia occurs is unclear. It is however believed to occur as a result of prolonged blocking of these receptors.

Some of the neuroleptic drugs, which are responsible for causing Tardive Dyskinesia include: Prochlorperazine, amoxapine, compazine, metoclopramide, haloperidol, flunarizine, fluphenazine, trifluoperazine hydrochloride and chlorpromazine.

It often usually takes months to years for tardive dyskinesia to develop from the use of neuroleptics; however, in some cases, this disorder can also develop in a matter of few weeks. Rarely, drugs containing selective serotonin reuptake inhibitors , lithium and norepinephrine reuptake inhibitors may also cause tardive dyskinesia; or can cause other syndromes, which are clinically difficult to differentiate.

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Medications That Cause Tardive Dyskinesia

Home » Medications that cause Tardive Dyskinesia

While tardive dyskinesia has been associated primarily with neuroleptic drugs, other medications can cause this condition, including some medications given for digestive troubles and nasal allergies. The longer a person is on a tardive dyskinesia inducing-drug the more likely he or she is to develop tardive dyskinesia. People over age sixty-five are more likely to develop drug-induced tardive dyskinesia than younger people are. As we age, our bodys metabolism and ability to process medication changes and slows; by age sixty these changes may already be apparent.

In February 2009, the connection between tardive dyskinesia and certain medications made the news, when the FDA announced that metoclopramide would be required to carry a black box label warning of the risk of tardive dyskinesia with long term use. Metoclopramide is an antiemetic prescribed for gastroparesis, severe acid reflux, and other problems; it is sold under the brand names: Reglan, Octamide, and Maxolon. Patients under sixty who use this drug for three months or more run the risk of developing tardive dyskinesia; people age sixty and older are especially vulnerable and may develop tardive dyskinesia after only a month on metoclopramide.

The following overview of drugs which can cause tardive dyskinesia is by no means exhaustive. Other medications not included here can also cause tardive dyskinesia.

Other Treatments For Tardive Dyskinesia

Some studies have suggested that lithium carbonate, which is frequently used in the treatment of bipolar disorder, may benefit patients with tardive dyskinesia; like so many other possible treatments for tardive dyskinesia there is not yet sufficient evidence to properly evaluate lithiums effectiveness in controlling the condition.

Amino acids have also shown promise in treating some cases of tardive dyskinesia, but again this treatment is still in the experimental stages. Vitamin B6 has also shown promise, but controlled studies have not been performed.

In one study, insulin seemed to reduce tardive dyskinesia in some patients, but this trial studied a limited number of patients; more studies on insulins benefits for tardive dyskinesia are needed before any conclusions can be drawn.

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Myth: Only The Older Antipsychotics Cause Tardive Dyskinesia

There are two kinds of antipsychotic drugs: typical antipsychotics and atypical antipsychotics . People who take first-generation antipsychotics are more likely to develop;tardive;dyskinesia than those who take second-generation antipsychotics, but the newer medications can still cause it, says Nucifora.

Treatment Procedures And Medication

Treatment for tardive dyskinesia is limited. Until recently, there was no effective means of treatment other than stopping the medication causing your symptoms, in cases in which it would be appropriate to do so. Now, though, two FDA-approved medications exist to treat tardive dyskinesia: valbenazine and deutetrabenazine. Both of these medications are vesicular monoamine transporter-2 inhibitors which block the release of neurotransmitters that cause abnormal movements, hopefully reducing the severity of tardive dyskinesia.

Neither medication available can cure tardive dyskinesia. They can, however, relieve debilitating symptoms.;

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How Do Antipsychotics Contribute To The Development Of Weight Gain T2dm And Dyslipidemia

Metabolic disturbances seen with antipsychotic usetypically manifest initially as weight gain that can advance to obesity.Cases of new onset DM associated with weight gain and independent ofweight gain have been reported in the literature.3 Second-generationantipsychotic therapy can contribute to rapid weight gain in thefirst few months of treatment, with weight gain continuing in somepatients for up to one year. Variation in weight gain exists and canrange from gains of 0.5 to 5.0 kg after 10 weeks of antipsychotictherapy.6 Given these risks, distinguishing the presence ofmetabolic syndrome is useful to proactively identify metabolic risk inpeople with mental illness. In addition to the presence of mentalillness, lifestyle factors such as increased food intake, intake ofparticularly high carbohydrate content drinks and snacks, limitedphysical activity, drug abuse, or tobacco smoking can all contribute tothe development of weight gain and obesity in this population.2

What Are The Risk Factors For Developing Tardive Dyskinesia

Though tardive dyskinesia is caused by certain drugs, some people have an increased likelihood of developing this condition. Known risk factors include:

• Prolonged medication use: The longer you take a drug that has the potential to cause tardive dyskinesia, the greater the risk.
• High dose of medication: As medication dosage increases, so does the chance of tardive dyskinesia.
• Older age: Adults over the age of 55 are at a higher risk, and it continues to increase with age.
• Cognitive impairment: A decline in mental abilities is associated with a higher risk of tardive dyskinesia.
• Sex: Women, especially post-menopausal, are more likely to have tardive dyskinesia than men.
• Substance abuse: Alcohol, illegal drugs, and cigarettes increase the prevalence of tardive dyskinesia.

Tardive dyskinesia can sometimes be reversed by stopping the medication thats causing it or by switching to a different one. Other times, you may require treatment with drugs specifically approved to treat the symptoms of tardive dyskinesia, including valbenazine and deutetrabenazine . But keep in mind, the best chance of full recovery occurs when tardive dyskinesia is diagnosed early. If you are taking a drug that can cause this condition, be sure to notify your doctor immediately if you begin having movements you cant control.

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What Are Symptoms Of Tardive Dyskinesia

Tardive dyskinesias are a symptom in themselves, characterized by extrapyramidal movements. Extrapyramidal movements refer to automatic movements and fixed, postural movements that are not visible. Extrapyramidal symptoms involve movement disorders such as:

• Restlessness/inability to sit still ;
• Involuntary and unpredictable body movements, ranging from fidgeting to problems with speech, swallowing, and posture
• Involuntary muscle contractions
• Involuntary muscle twitching or jerking
• Repetitive movements, gestures, word repetition
• Sudden repeated, twitches, movements, or sounds

What Should You Do If You Take Medication That Causes Td

If you take a drug that is known to cause TD, but you do not at this time have symptoms and it worries you, talk to your doctor right away, ask questions and let him know your concerns. He will be able to assess TD symptoms with something called the Abnormal Involuntary Movement Scale scale. This assessment should be done about every six months

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Fact: The Risk Of Developing Tardive Dyskinesia Increases The Longer You Take An Antipsychotic

Approximately one in four people who receive long-term treatment with an antipsychotic medication will experience tardive;dyskinesia, according to the NAMI. And, says Nucifora, taking higher doses of the antipsychotic can also add to the risk of developing the condition.

Although;tardive;dyskinesia can occur from short-term use, it usually doesnt appear before the three-month mark, says Nucifora. Adds Anhar;Hassan, MB, BCh, a neurologist at the Mayo Clinic in Rochester, Minnesota: Tardive;dyskinesia also rarely occurs after a single dose.

Because;tardive;dyskinesia is linked with long-term use of antipsychotics, the NAMI recommends that people taking these medications be closely monitored and screened by their doctor.

Stages And Types Of Tardive Dyskinesia

Tardive dyskinesia falls under the umbrella of extrapyramidal symptoms which include tardive dystonia, akinesia, akathisia, bradykinesia, and parkinsonism. Extrapyramidal symptoms are considered movement disorders caused by the same medications that cause tardive dyskinesia.

Tardive dyskinesia is considered one of the most severe forms of extrapyramidal symptoms, said Dr. George Hadeed, MD, a board-certified psychiatrist based in Tucson, Arizona. The presence of extrapyramidal symptoms may worsen over time, and may be an indicator of progression to tardive dyskinesia.

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Myth: People Who Develop Tardive Dyskinesia Should Stop Taking Their Medicine Asap

Although you should talk to your doctor right away about any involuntary movements youre experiencing, you shouldnt stop taking the drug on your own, says Hassan. Halting the medication without speaking to your doctor first can be risky, she says. And sometimes, reducing the medication can worsen the dyskinesia and make it more challenging to treat, she says.

If your physician decides to change your current medication, the;tardive;dyskinesia may stop, says Hassan. And even if the symptoms dont go away completely, says Nucifora, the progression of the disorder may be halted or slowed by stopping use of the drug.

Diabetes Status Female Status Among Risk Factors For Tardive Dyskinesia

Some of the non-modifiable risk factors found were determined to be patient-related — such as older age, female sex, and white or African descent.

Some modifiable comorbidities for tardive dyskinesia may include diabetes, smoking, and alcohol and substance abuse, according to a recent meta analysis.

Researchers from Padua, Italy and Long Island, New York conducted a literature review of 41 papers discussing risk factors for TD, in hopes of categorizing modifiable and non-modifiable patient and illness related variables and comorbidities.

The results show that most risk factors for TD are modifiable, study author Marco Solmi, MD, PhD told MD Magazine. With concise patient clinical history collection, assessment of comorbidity, routine screening for early dyskinetic movements, and choice of second-generation antipsychotics over first-generation, TD risks could be lowered.

However, no prevention trial has been run to date to test such a preventive approach, which may be the aim of future clinical research to minimize tardive dyskinesia incidence, Solmi said.

Some of the non-modifiable risk factors that the researchers determined were patient-related such as older age, female sex, and white or African descent. They noted that Asian race seems to be a protective factor against tardive dyskinesia, compared with other races.

Mood disorder associations seem to refer mostly to first generation antipsychotic effects used in the literature review, the researchers found.

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Medications And Supplements Used To Treat Tardive Dyskinesia

A number of medications and supplements have been identified that ameliorate TD symptoms.

Cholingergic Agents.

Cholinergic agents are used as muscle stimulants to diagnose myasthenia gravis and to treat glaucoma. These agents can also improve the Parkinsonian features of TD. Donepezil, a reversible acetylcholinesterase inhibitor, is currently the only cholinergic medication that has shown benefit against TD. Overall, however, cholinergic agents are not a widely accepted treatment for TD as sufficient evidence is lacking to suggest they are more helpful than other treatments.

Clozapine, Quetiapine, Olanzapine, and Apomorphine.

Clozapine, a serotonin and dopamine receptor antagonist, is an atypical APD used to treat schizophrenia. Clozapine is the best current medication recommended for patients who require antipsychotics and simultaneously have TD, as clozapine has been reported to reverse TD symptoms., Clozapine has been linked to TD; however, the incidence is much lower compared to other atypical APDs. Drugs with similar mechanisms of action such as quetiapine, a weak striatal dopamine antagonist, and olanzapine, a dopamine and serotonin receptor antagonist, have also been shown to be effective in ameliorating TD symptoms. Apomorphine, a dopamine receptor antagonist, can be given in conjunction with L-DOPA to decrease dyskinesias.

Tetrabenazine Analogs.

Clonazepam.

Propranolol.

Amantadine.

Branched-Chain Amino Acids.

Ginkgo Biloba.

Antioxidant Medications and Supplements.

Adverse Effects Of Antipsychotic Medications

JOHN MUENCH, MD, MPH, Oregon Health & Science University, Portland, Oregon

ANN M. HAMER, PharmD, BCPP, Oregon State University College of Pharmacy, Corvallis, Oregon

Am Fam Physician.;2010;Mar;1;81:617-622.

• References

SORT: KEY RECOMMENDATIONS FOR PRACTICE

FGAs with lower potency dopamine D2 neuroreceptor blockade are no more likely than most SGAs to cause extrapyramidal symptoms.

FGAs = first-generation antipsychotics; SGAs = second-generation antipsychotics.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .

SORT: KEY RECOMMENDATIONS FOR PRACTICE

FGAs = first-generation antipsychotics; SGAs = second-generation antipsychotics.

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What Other Drugs Are Associated With Tardive Dyskinesia

Tardive dyskinesias abnormal movements, such as grimacing, sticking out your tongue, or tapping your feet, can also occur after taking other medications for an extended period of time. Some of these medications have a similar effect on dopamine receptors like antipsychotics, while others may have a different mechanism of action. Researchers continue to study this. Other drugs that may cause tardive dyskinesia include:

• Drugs to treat nausea and vomiting, such as metoclopramide and prochlorperazine
• Antidepressants, such as amitriptyline and fluoxetine
• Medications to treat Parkinsons disease, such as levodopa
• Seizure medications, such as phenobarbital and phenytoin
• Mood stabilizers, such as lithium

A List Of Medications That Can Cause Td

Here is a list of medications that can cause Tardive Dyskinesia :

Neuroleptic drugs

• Clozaril
• Geodon

• Cocaine and other street drugs
• Elavil

• Clozapine
• Botulinum toxin

There are side effects to some these medications, so caution is needed. Clozapine has some serious side effects and requires a lot of monitoring and regular blood work.

In the last year, the FDA has approved two new drugs for the treatment of TD.4 Here is a list:

Ingrezza . A clinical trial of 234 people suffering from TD, after six weeks there was a significant improvement.

Austedo . Originally FDA approved for chorea associated with Huntington’s Disease, It was shortly found to help with TD.

Ken Duckworth MD, President of NAMI, offers hope with these two new medications. “I have felt a bit helpless in the past when I see people who experience TD. We didnât have any treatment options approved by the FDA. But now we have two new tools and I look forward to learning more about these medications from my patientsâ experiences and scientific literature.”

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What About Weight Change

In a long-term study,patients on CAPLYTA for one year had an average weight loss of 7 pounds

CAPLYTA, like other drugs used to treat schizophrenia, may cause problems with your metabolism, including high blood sugar, diabetes, increased fat levels in your blood, and weight gain. Your doctor should check your blood sugar, fat levels, and weight before you start and during your treatment with CAPLYTA. Extremely high blood sugar levels can lead to coma or death. Tell your doctor if you have symptoms of high blood sugar, which include feeling very thirsty, hungry, sick to your stomach, weak/tired, or needing to urinate more than usual.

Each drug has its own specific risk profile.