Can a Person with Tardive Dyskinesia Drive?
Yes, a person with tardive dyskinesia can generally drive, but this depends entirely on the severity and location of the involuntary movements and whether they impair the person's ability to safely control a vehicle.
Assessment Framework for Driving Fitness
The key determination is whether the involuntary movements cause functional impairment that would compromise vehicle control or safety:
Movements That May Impair Driving Ability
- Truncal and extremity involvement - TD affecting the trunk or limbs could directly interfere with steering, braking, or accelerating 1, 2
- Severe orofacial movements - While primarily involving the face, mouth, and tongue, severe cases may cause distraction or secondary effects that impair concentration 1, 2
- Respiratory dyskinesia - This variant can cause dyspnea and may lead to sudden breathing difficulties while driving 1
Movements Less Likely to Impair Driving
- Mild orofacial dyskinesia - Isolated facial grimacing, tongue movements, or chewing without limb involvement typically does not prevent safe vehicle operation 1, 2
- Well-controlled symptoms - Patients successfully treated with VMAT2 inhibitors (valbenazine or deutetrabenazine) who have minimal residual movements 2, 3
Clinical Evaluation Points
When assessing driving fitness, evaluate:
- Severity of movements - Use the Abnormal Involuntary Movement Scale (AIMS) to objectively quantify movement severity 2, 3
- Body regions affected - Determine if movements involve the extremities or trunk versus isolated orofacial involvement 1, 2
- Functional impact - Directly observe whether the patient can perform motor tasks requiring coordination and sustained attention 2
- Medication effects - Consider sedation from antipsychotics or other medications that may compound impairment 1, 4
Important Caveats
There are no specific driving guidelines for tardive dyskinesia itself - Unlike cardiac arrhythmias where explicit driving restrictions exist 1, TD lacks formal regulatory guidance, placing the burden on clinical judgment.
The underlying psychiatric condition requiring antipsychotic treatment may pose greater driving risk than the TD itself, particularly if the patient has active psychosis, severe mood symptoms, or cognitive impairment 1, 2.
Anticholinergic medications used to treat drug-induced parkinsonism can worsen TD and should be avoided, as they may inadvertently increase movement severity 2, 3.
Management to Optimize Driving Safety
- Treat moderate to severe TD with VMAT2 inhibitors (valbenazine or deutetrabenazine) as first-line therapy to reduce movement severity 2, 3
- Switch to lower-risk antipsychotics such as clozapine, quetiapine, or aripiprazole if continued dopamine blockade is necessary 2, 5
- Gradual dose reduction of the offending antipsychotic if clinically feasible, as TD may improve with medication discontinuation 2, 6
- Regular monitoring every 3-6 months using AIMS to track progression or improvement 2, 7
Practical Recommendation
For mild to moderate orofacial TD without limb involvement, driving is generally safe. For TD involving the extremities or trunk, or causing significant functional impairment, driving should be restricted until symptoms improve with treatment 1, 2. Document your assessment of functional capacity and discuss driving safety explicitly with the patient 2, 3.