Drug induced movement disorders (DIMD) is a common condition and it is one of the causes for movement disorders. DIMD is a big burden in the community and most of the time the doctors, nurses and pharmacists fail to identify or evaluate the patients for DIMD; therefore, it might go unrecognized for a certain period of time.

What Medications Cause Movement Disorders?

Metoclopramide, prochlorperazine, haloperidol, chlorpromazine, fluphenazine, thioridazine, trifluoperazine, thiothixene, and molindone are medications common to cause all 4 types of movement disorders mentioned here.

Types of drug induced movement disorders and medications causing it:

There few types of DIMD’s and certain medications cause certain types DIMD. However, in some patients all four types can be present simultaneously and most of the symptoms in each type overlap with the other types. The medications causing the four types of movement disorders are all most the same except for few changes. Mostly the typical antipsychotics and some antiemetics are the main group of medications causing movement disorders.

Dystonia

Dystonia can be acute or tardive (delayed) dystonia. There are involuntary, twisting, repetitive movements are the main feature in dystonia. These movements can be present in the upper limbs, lower limbs, back, neck, tongue and vocal cords. So, abnormal posture, facial grimacing, jaw opening and closing, rhythmic tongue protrusion, uncontrolled limb movements, elevation of the visual gaze in both eyes and sometimes difficulty in breathing and noisy breathing are seen. Acute dystonia usually occurs after 2-5 days of initiation of the drug. Distress is associated with the symptoms and pain might be present with the symptoms.

Antiemetics

  • Metoclopramide
  • Prochlorperazine
  • Promethazine

Psychotropics

  • Haloperidol
  • Chlorpromazine
  • Fluphenazine
  • Thioridazine
  • Trifluoperazine
  • Molindone
  • Thiothixene
  • Olanzapine – high doses
  • Risperidone – high doses

Parkinsonism

DIMD is the second most common type of parkinsonism after primary parkinsonism. The same features seen in parkinsonism is present. The main symptoms are tremors, rigidity, slowness in the movement (dyskinesia) and imbalance. Dopamine receptor-blocking medications (DRBD) are the commonest medications to cause parkinsonism and most of the time this is not recognized as the facial grimacing, lack of energy, and slowness can be identified as the negative symptoms of schizophrenia. The main reason for drug induced parkinsonism is lack of recognition and prescribing DRBD’s without proper evaluation of the patient. Cessation of the drug can resolve the symptoms and sometimes this might take about 18 months.

Antiemetics

  • Metoclopramide
  • Prochlorperazine
  • Promethazine

Antiepileptics

  • Sodium valproate

Cardiovascular agents

  • Alpha-methyldopa

Psychotropics

  • Haloperidol
  • Chlorpromazine
  • Fluphenazine
  • Thioridazine
  • Trifluoperazine
  • Molindone
  • Thiothixene
  • Olanzapine – high doses
  • Risperidone – high doses

Vestibular agents

  • Cinnarizine
  • Flunarizine

Tardive Dyskinesia

Most of the DRBD’s are the reason for tardive dyskinesia. The word tardive means a delay in the involuntary movements, sometimes it takes about one month to develop the symptoms after being exposure to the drug. If the drug is continued the symptoms might be present until it’s stopped. The classic symptoms are well-coordinated and repetitive movements of the mouth, tongue, jaw and lips which are called oro-Bucco-lingual dyskinesia (OBLD). Lip smacking, jaw movements (chewing something), cheek puffing, and tongue writhing, thrusting can be seen. Additionally, sometimes abnormal trunk movements, and limb movements can also be present. The other movement disorders such as dystonia, parkinsonism and akathisia can be present simultaneously.

Antiemetics

  • Metoclopramide
  • Prochlorperazine

Antiepileptics

  • Phenytoin

Psychotropics

  • Haloperidol
  • Lithium
  • Amoxapine
  • Chlorpromazine
  • Fluphenazine
  • Thioridazine
  • Trifluoperazine
  • Molindone
  • Thiothixene
  • Olanzapine – high doses
  • Risperidone – high doses

Akathisia

The word akathisia means “not to sit”, this is the only type of movement disorder that does not have an idiopathic origin. The symptoms are restlessness, repetitive movements such as crossing and uncrossing the legs repeatedly while sitting, marching at the same place. Acute akathisia is when the symptoms develop soon after the initiation or increasing the dose of the drug, sometimes symptoms can develop even after a month.

Antiemetics

  • Metoclopramide
  • Prochlorperazine
  • Promethazine

Antiepileptics

  • Carbamazepine

Psychotropics

  • Lithium
  • Haloperidol
  • Lithium
  • Amoxapine
  • Chlorpromazine
  • Fluphenazine
  • Thioridazine
  • Trifluoperazine
  • Molindone
  • Thiothixene
  • Selective serotonin reuptake inhibitors
  • Tricyclic antidepressants

Conclusion

Drug induced movement disorders (DIMD) is a common condition and it is one of the causes for movement disorders. DIMD is a big burden in the community and most of the time the doctors, nurses and pharmacists fail to identify or evaluate the patients for DIMD, therefore it might go unrecognized for a certain period pf time. There are four types of movement disorders caused by medications dystonia, parkinsonism, tardive dyskinesia and akathisia. Metoclopramide, prochlorperazine, haloperidol, chlorpromazine, fluphenazine, thioridazine, trifluoperazine, thiothixene, and molindone are medications common to cause all 4 types of movement disorders.

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: March 25, 2019

This article does not provide medical advice. See disclaimer

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