Drug induced? parkinsonism

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10+ Year Member
Oct 18, 2008
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What’s your strategy? Schizoaffective pt well controlled from a mood stability/staying out of confinement and not wilding out POV on LAI 2gen antipsychotic - pt understandably not much willing to risk relapse to mania - but with progressively disabling Parkinsonian symptoms.

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Cogentin or artane. Or if you’re a nurse practitioner I worked with bromocriptine, though that’s at LEAST 2nd line IMO /s.
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You can also consider cross taper to a less D2 blocking, or different antipsychotic, or slowly reducing the dose. I've had good results reversing iatrogenic parkinsonism by switching patients to abilify maintena from risperdal consta. Sometimes I will add low dose longer acting lower potency oral antipsychotic for breakthrough psychosis, which I have been able to discontinue many times once the patient is improved. Frequent follow up and avoiding huge sudden changes if managing outpatient seems to help.
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If symptoms are asymmetric, tremor predominant, you might be looking at progressive parkinsonian syndrome perhaps exacerbated by antipsychotics. For drug-induced parkinsonism, it portends TD development, so I'm quite careful and usually want to switch antipsychotics. I don't like the toxicity of anticholinergics and would really only consider their long-term use when there is compelling reason that switching antipsychotics is dangerous.

Certainly clozapine is the ultimate option if appropriate otherwise.
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