Can the cost contribute to the onset of dyskinesia (involuntary movements)?

From the Guidelines

The cost of medications can indirectly contribute to the onset of dyskinesia, particularly in patients taking antipsychotic medications, as inconsistent intake due to financial constraints can lead to fluctuating dopamine levels in the brain. When patients cannot afford their prescribed antipsychotic medications, such as risperidone or olanzapine, they may take doses irregularly, skip doses, or discontinue treatment altogether, which can increase the risk of developing tardive dyskinesia, a side effect associated with long-term use of these medications 1. According to the guidelines for managing Alzheimer's disease, typical antipsychotic agents, such as haloperidol, are associated with a significant risk of irreversible tardive dyskinesia, which can develop in 50% of elderly patients after continuous use for 2 years 1. Some key points to consider in managing the cost of medications and minimizing the risk of dyskinesia include:

• Discussing cost concerns with healthcare providers to explore alternative treatment options, such as switching to generic medications or applying for patient assistance programs
• Maintaining consistent medication intake to minimize fluctuations in dopamine levels
• Regularly monitoring patients for signs of dyskinesia, particularly those taking antipsychotic medications long-term
• Considering the use of atypical antipsychotic agents, which have a lower risk of extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1.

From the FDA Drug Label

Dyskinesias The occurrence of dyskinesias may require dosage reduction.

Because carbidopa permits more levodopa to reach the brain and more dopamine to be formed, certain adverse central nervous system (CNS) effects, e.g., dyskinesias (involuntary movements), may occur at lower dosages and sooner with carbidopa and levodopa orally disintegrating tablets than with levodopa alone.

• Dyskinesia can be a side effect of levodopa treatment, and its onset may be related to the start of treatment with levodopa, as it is associated with the formation of dopamine in the brain 2 2.
• The development of dyskinesias may require a dosage reduction of levodopa 2.
• It is essential to monitor patients for the development of dyskinesias, especially when initiating treatment with levodopa or adjusting the dosage 2.

From the Research

Cost and Onset of Dyskinesia

• The cost of dyskinesia is not directly addressed in the provided studies, but the onset and management of levodopa-induced dyskinesia (LID) are discussed in several studies 3, 4, 5, 6, 7.
• According to these studies, LID is a common complication of long-term levodopa treatment in Parkinson's disease (PD) patients, affecting approximately 80% of patients in advanced stages of the disease 3.
• The exact mechanisms underlying dyskinesia are still unclear, but factors such as nigrostriatal degeneration, pulsatile stimulation of striatal postsynaptic receptors, and non-dopaminergic neurotransmitter systems are thought to contribute to its development 4.
• The studies suggest that delaying the initiation of levodopa treatment does not prevent the development of dyskinesia, as its onset is a function of disease duration rather than cumulative levodopa exposure 6.
• Current treatments for LID include amantadine, drugs targeting 5-hydroxytryptamine receptors, and surgery, as well as strategies to improve levodopa delivery and reduce its pulsatile stimulation 3, 4, 6.

Management and Treatment of Dyskinesia

• The management of LID involves a range of pharmacological and surgical approaches, including the use of dopamine agonists, monoamine oxidase B inhibitors, and glutamate-release inhibitors 4, 5, 7.
• Dopamine agonists, such as pergolide and apomorphine, may help reduce the risk of dyskinesia induction by providing continuous, rather than pulsatile, dopaminergic stimulation 5.
• Other treatments, such as amantadine and clozapine, may be effective in managing LID, but their use is often limited by side effects and other complications 4, 7.
• The studies emphasize the need for further research into the pathogenesis and treatment of LID, as well as the development of more effective and targeted therapies for this common complication of PD treatment 3, 4, 6.