From the Guidelines
Medications such as antipsychotics, antidepressants, anticonvulsants, opioids, and stimulants can cause myoclonic jerks as a side effect. Common culprits include certain antipsychotics like clozapine 1; antidepressants such as SSRIs and tricyclics; anticonvulsants including levetiracetam, gabapentin, and lamotrigine; and opioids like morphine and hydrocodone. Stimulants such as amphetamines, methylphenidate, and caffeine can also trigger these jerks.
Medication Classes Associated with Myoclonic Jerks
- Antipsychotics:
- Clozapine 1
- Other typical and atypical antipsychotics
- Antidepressants:
- SSRIs (e.g., fluoxetine, sertraline)
- Tricyclics (e.g., amitriptyline)
- Anticonvulsants:
- Levetiracetam
- Gabapentin
- Lamotrigine
- Opioids:
- Morphine
- Hydrocodone
- Stimulants:
- Amphetamines
- Methylphenidate
- Caffeine
Management of Myoclonic Jerks
If you experience myoclonic jerks while taking any medication, don't stop taking it abruptly, but consult your healthcare provider promptly. They may adjust your dosage, switch to an alternative medication, or implement strategies to manage this side effect while maintaining necessary treatment 1. It's essential to weigh the benefits of the medication against the potential risk of myoclonic jerks and discuss any concerns with your healthcare provider.
From the FDA Drug Label
CONTRAINDICATIONS Prozac is contraindicated in patients known to be hypersensitive to it Monoamine oxidase inhibitors — There have been reports of serious, sometimes fatal, reactions (including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma) in patients receiving fluoxetine in combination with a monoamine oxidase inhibitor (MAOI), and in patients who have recently discontinued fluoxetine and are then started on an MAOI. The medications that can cause myoclonic jerks are:
- Monoamine oxidase inhibitors (MAOIs) in combination with fluoxetine
- Fluoxetine in combination with a monoamine oxidase inhibitor (MAOI) 2
From the Research
Medications that can cause myoclonic jerks
- Antipsychotic medications, particularly those that block dopamine receptors, can cause extrapyramidal symptoms, including myoclonus 3
- Selective serotonin reuptake inhibitors (SSRIs) can cause myoclonus, especially when used in combination with other medications that increase serotonergic transmission 3, 4
- Anticonvulsant mood stabilizers, such as valproic acid, can cause myoclonus and other movement disorders 3
- Lithium can cause myoclonus, as well as other movement disorders like tremors and parkinsonism 3, 4
- Benzodiazepines can cause ataxia, which may be associated with myoclonic jerks 3, 4
Non-antipsychotic medications that can cause myoclonic jerks
- Certain antidepressants, such as tricyclic antidepressants (TCAs) and SSRIs, can cause myoclonus and other movement disorders 5, 4
- Antiemetics and oral-contraceptive agents can also cause extrapyramidal symptoms, including myoclonus, although this is rare 5
- Anticonvulsants, such as clozapine, can cause myoclonus and other movement disorders 3, 4
Management of myoclonic jerks caused by medications
- Reducing the dose of the offending medication or switching to a different medication with less potential for causing myoclonus may be effective in managing symptoms 6, 7
- Adding an anticholinergic agent or a beta-blocker may also help alleviate symptoms 7
- In some cases, discontinuing the medication may be necessary to resolve symptoms 4