From the Guidelines
Benadryl (diphenhydramine) is not recommended for treating tardive dyskinesia in Regan. While anticholinergic medications like Benadryl may temporarily mask symptoms of tardive dyskinesia, they do not treat the underlying cause and can actually worsen the condition in the long term 1. According to the American Psychiatric Association practice guideline for the treatment of patients with schizophrenia, APA recommends (1B) that patients who have moderate to severe or disabling tardive dyskinesia associated with antipsychotic therapy be treated with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2) 1.
Some key points to consider in treating tardive dyskinesia include:
- FDA-approved medications specifically for tardive dyskinesia such as valbenazine (Ingrezza) or deutetrabenazine (Austedo) should be considered as first-line treatments
- These VMAT2 inhibitors work by regulating dopamine release in the brain and have demonstrated efficacy in reducing involuntary movements
- If Regan is currently taking an antipsychotic medication that may be causing tardive dyskinesia, her doctor might consider reducing the dose, switching to a different antipsychotic with lower risk (such as an atypical antipsychotic), or discontinuing the medication if clinically appropriate
- Benadryl may also worsen cognitive function, cause sedation, and has anticholinergic side effects that could be problematic, especially in older patients 1.
In terms of management, it is crucial to follow the APA recommendations for treating patients with schizophrenia, including the use of evidence-based nonpharmacological and pharmacological treatments, and to monitor for effectiveness and side effects 1.
From the Research
Treatment Options for Tardive Dyskinesia
- 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, but for many patients, this is not possible due to disease relapse 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.
Use of VMAT Inhibitors
- The strongest evidence for a suitable co-intervention to treat tardive dyskinesia comes from tests with the new VMAT inhibitors, deutetrabenazine and valbenazine 2.
- Deutetrabenazine and valbenazine have been shown to be effective in reducing tardive dyskinesia symptoms, with a number needed to treat (NNT) of 5 and 4, respectively 3, 4.
- Valbenazine is a reversible inhibitor of Vesicular Monoamine Transporter Type 2 (VMAT2) and has been approved for the treatment of tardive dyskinesia in adults 5, 4, 6.
Benadryl (Diphenhydramine) for Tardive Dyskinesia
- There is no evidence to suggest that Benadryl (diphenhydramine) is an effective treatment for tardive dyskinesia 2, 3, 5, 4, 6.
- The use of Benadryl (diphenhydramine) for tardive dyskinesia is not recommended, and other treatment options such as VMAT inhibitors should be considered instead 2, 3, 5, 4, 6.