From the Research
Stimulant-induced dyskinesias should be managed by dose reduction or discontinuation of the offending stimulant, with consideration of switching to a different stimulant class or adding a low-dose antipsychotic medication, as these dyskinesias can significantly impact quality of life and morbidity if left unaddressed. The management of stimulant-induced dyskinesias is crucial to prevent progression to more severe or potentially permanent movement disorders. Key considerations in managing stimulant-induced dyskinesias include:
- Dose reduction or discontinuation of the offending stimulant
- Switching to a different stimulant class, such as changing from amphetamine-based medications to methylphenidate or vice versa
- Adding a low-dose antipsychotic medication, like risperidone (0.25-1mg daily) or aripiprazole (2.5-5mg daily), to control dyskinetic movements while continuing stimulant therapy, as seen in studies such as 1 The pathophysiology of stimulant-induced dyskinesias involves the increase of dopamine levels in the brain, particularly in the basal ganglia, which controls movement, as discussed in 2 and 3. Excessive dopamine signaling disrupts the normal balance of neurotransmitters, leading to these abnormal movements. Patients with pre-existing movement disorders, those taking high doses of stimulants, or those with prolonged stimulant use are at higher risk, highlighting the need for regular monitoring for early signs of dyskinesia, as early intervention can prevent progression to more severe or potentially permanent movement disorders, as noted in 4 and 5. In clinical practice, the most recent and highest quality study, such as 4, should guide management decisions to prioritize morbidity, mortality, and quality of life outcomes.