What are the long-term side effects of stimulant-induced dyskinesias after discontinuation of stimulant (Central Nervous System stimulant) medication?

From the Guidelines

Stimulant-induced dyskinesias can persist after discontinuation of the medication, though most cases resolve within weeks to months after stopping the stimulant. Common stimulants that can cause dyskinesias include methylphenidate (Ritalin, Concerta), amphetamine salts (Adderall), and lisdexamfetamine (Vyvanse) 1. These movement disorders typically present as repetitive, involuntary movements such as tics, tremors, or choreiform movements. If you experience dyskinesias after stopping stimulants, it's essential to consult with a neurologist or movement disorder specialist.

Some key points to consider when managing stimulant-induced dyskinesias include:

• The potential for persistent movement disorders after stimulant discontinuation, particularly in individuals with genetic predispositions or those who used high doses for extended periods 1
• The importance of monitoring vital signs, including blood pressure and pulse, during stimulant treatment, as these medications can cause increases in these parameters 1
• The need for careful documentation of prior treatments and selection of the order of stimulants to be used, as well as consistent titration schedules and assessment of drug response 1
• The potential for long-term side effects, such as reduced growth velocity, which can be associated with stimulant use, particularly at higher doses and with consistent administration 1

Treatment may include medications such as tetrabenazine (25-100 mg daily), valbenazine (40-80 mg daily), or deutetrabenazine (6-48 mg daily) for persistent cases, as well as benzodiazepines like clonazepam (0.5-2 mg daily) for temporary relief 1. It is crucial to prioritize the management of stimulant-induced dyskinesias to minimize their impact on morbidity, mortality, and quality of life.

From the Research

Stimulant-Induced Dyskinesias

• Stimulant-induced dyskinesia is a potential side effect of medications used to treat ADHD, as reported in a study published in 2020 2.
• The study found that children with ADHD who were treated with methylphenidate had higher scores on the Abnormal Involuntary Movement Scale (AIMS) than those who were treatment-naive or healthy controls.

Long-Term Side Effects After Discontinuation

• Tardive dyskinesia (TD) is a movement disorder that can occur after long-term treatment with antipsychotic medications, and can be irreversible 3, 4.
• The risk of developing TD remains even with the use of atypical antipsychotic drugs, and other medication classes can also induce TD 3.
• Early diagnosis and treatment of TD are crucial to prevent permanence, and clinicians should be educated on the risks and alternatives to antipsychotic medication 4.

Treatment of Stimulant-Induced Dyskinesias

• Treatment strategies for drug-induced dyskinesias include slow taper of the offending agent, use of dopamine-depleting agents, and botulinum toxin for focal dystonia 5.
• New treatment approaches for persistent TD, such as vesicular monoamine transporter-2 (VMAT2) inhibitors, are available and approved by the US Food and Drug Administration 4.

Combined Pharmacotherapy

• Combined methylphenidate and atomoxetine pharmacotherapy can be effective in treating ADHD, but can also have side effects such as irritability, appetite reduction, and palpitations 6.
• The efficacy and safety of combined pharmacotherapy should be carefully monitored, and patients should be educated on the potential risks and benefits 6.