From the Guidelines
Tardive dyskinesia is characterized by rapid involuntary facial movements, such as blinking, grimacing, chewing, or tongue movements, and extremity or truncal movements, which can occur as a side effect of long-term use of dopamine receptor blocking agents, particularly first-generation antipsychotics like haloperidol, but can also occur with second-generation antipsychotics and certain antiemetics like metoclopramide 1.
Signs and Symptoms
- Involuntary, repetitive movements typically affecting the face, mouth, and tongue
- Common signs include lip smacking, tongue protrusion, grimacing, blinking, chewing motions, and jaw movements
- Patients may also experience rocking, jerking, or twisting movements of the neck, trunk, arms, and legs
- These movements are often rhythmic and purposeless, occurring without the patient's awareness
Risk Factors
- Older age
- Female gender
- Longer duration of medication use
- Higher cumulative medication doses
Underlying Mechanism
- Hypersensitivity of dopamine receptors in the basal ganglia following chronic blockade, leading to dysregulated movement control when the medication is reduced or discontinued 1
Prevention and Management
- Strategies for prevention and early detection need to be followed, including baseline measures of abnormal movements and regular assessment for dyskinesias 1
- If tardive dyskinesia occurs, attempts should be made to either lower the dose or switch to another medication, most likely an atypical antipsychotic 1
From the FDA Drug Label
Clinicians should be alerted to the signs and symptoms associated with NMS. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia) Additional signs may include elevated creatinine phosphokinase, myoglobinuria, rhabdomyolysis, and acute renal failure.
The signs and symptoms of tardive dyskinesia are not directly stated in the provided drug labels. However, the labels do mention akathisia, agitation, and restlessness as potential adverse reactions, as well as parkinsonism, which can include symptoms such as:
- Bradykinesia
- Gait disturbances
- Tremor These symptoms can be associated with tardive dyskinesia, but the labels do not provide a direct answer to the question. 2
From the Research
Signs and Symptoms of Tardive Dyskinesia
- Tardive dyskinesia is a movement disorder characterized by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication 3
- The disorder is often stigmatizing, with purposeless, rapid, repetitive, stereotypic, involuntary movements of the face, limbs, or trunk 4
- The prevalence of tardive dyskinesia is reported to be 32% with typical antipsychotics and 13% with atypical antipsychotics 5
- Symptoms of tardive dyskinesia can be ameliorated with treatment, including the use of valbenazine, a selective inhibitor of vesicular monoamine transporter 2 (VMAT2) 4, 6
Characteristics of Tardive Dyskinesia
- Tardive dyskinesia is associated with the long-term use of antipsychotic medication, particularly typical neuroleptics or centrally acting dopamine receptor blocking antiemetics 4
- The disorder can be caused by the use of dopamine blocking agents, which can lead to excessive movement 7
- Tardive dyskinesia can be characterized by a range of abnormal involuntary movements, including facial grimacing, tongue protrusion, and limb movements 4, 6
Treatment-Related Signs and Symptoms
- The use of valbenazine to treat tardive dyskinesia can lead to a reduction in symptoms, with a reported response rate of 40.0% in clinical trials 6
- Common adverse events associated with valbenazine include somnolence, fatigue, and sedation, with a reported rate of 10.9% in clinical trials 6
- Valbenazine can also prolong the ECG QT interval, although this is not considered a contraindication for use 6