From the Guidelines
Benadryl (diphenhydramine) is not recommended as an effective treatment for tardive dyskinesia. While diphenhydramine may temporarily mask symptoms in some cases due to its anticholinergic properties, it does not address the underlying mechanism of tardive dyskinesia and is not considered appropriate therapy. In fact, anticholinergic medications like Benadryl may actually worsen tardive dyskinesia in the long term or mask symptoms while allowing the condition to progress.
Key Points to Consider
- The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia 1 recommends treating patients with moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2).
- FDA-approved treatments for tardive dyskinesia include valbenazine (Ingrezza) and deutetrabenazine (Austedo), which are specifically designed to address the dopamine dysregulation that causes tardive dyskinesia.
- These medications typically require daily dosing and regular monitoring by a healthcare provider.
- Tardive dyskinesia results from prolonged exposure to dopamine receptor blocking agents (typically antipsychotics), causing hypersensitivity of dopamine receptors, and requires targeted therapy rather than symptom masking with antihistamines like Benadryl.
Treatment Approach
- The goal of treatment should be to address the underlying mechanism of tardive dyskinesia, rather than just masking symptoms.
- Patients with tardive dyskinesia should be treated with evidence-based therapies, such as VMAT2 inhibitors, under the guidance of a healthcare provider.
- Regular monitoring and follow-up are crucial to ensure the effectiveness of treatment and to minimize potential side effects.
From the Research
Tardive Dyskinesia Treatment
- Tardive dyskinesia is a movement disorder characterized by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication 2.
- The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible 2.
- Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may be effective in reducing tardive dyskinesia symptoms 2.
Benadryl (Diphenhydramine) for Tardive Dyskinesia
- There is no evidence to suggest that Benadryl (diphenhydramine) is effective for reducing tardive dyskinesia symptoms 2, 3, 4, 5, 6.
- The strongest evidence for a suitable co-intervention to treat tardive dyskinesia comes from tests with the new VMAT inhibitors, deutetrabenazine and valbenazine 2, 3, 4, 5, 6.
FDA-Approved Medications for Tardive Dyskinesia
- Valbenazine and deutetrabenazine are FDA-approved medications for the treatment of tardive dyskinesia 3, 4, 5, 6.
- These medications have demonstrated efficacy in several class 1 studies and should be tailored to the individual patient 5.
- Vitamin E may also be a potential treatment option for tardive dyskinesia, although more research is needed to confirm its effectiveness 3.