Drug Induced Parkinson disease

Related Subjects: Multiple System Atrophy (MSA) |Parkinson Plus syndromes |Parkinsonism |Idiopathic Parkinson disease |Progressive Supranuclear Palsy |Drug Induced Parkinson disease

High risk with dopamine D2-receptor blocking actions, including haloperidol but may be seen with drugs such as metoclopramide

About

• History of dopamine blocker use - Drugs used to treat schizophrenia and other psychotic disorders such as behavioral disturbances in people with dementia
• Seen in 7% of those with signs of PD

Aetiology

• Dopamine blockers
• Peripheral:antiemetics
• Central:neuroleptics

Causative drugs

• Prochlorperazine (Stemetil), Metoclopromide
• Diltiazem, Captopril, Sodium valproate, Lithium
• MPTP - synthesized alternative to Heroin
• Dopamine depleters e.g. Tetrabenazine
• Reserpine and alpha-methyldopa
• Thalidomide,cytarabine,ifosfamide,vincristine
• Tamoxifen,and cytosine arabinoside

Risks Groups

• Elderly, Female, AIDS
• High dose dopamine blockers
• Preclinical Idiopathic PD
• Those with tardive dyskinesias

Clinical

• Subacute symmetrical onset symptoms and signs
• Early presence of postural tremor
• Concurrent oral-buccal dyskinesias
• History of dopamine blocker use
• Akinesia, Bradykinesia

Differentials

• Idiopathic Parkinson's disease

Investigations

• CT/MRI may be needed

Management

• Prompt recognition is the key. The next step is the discontinuation of the culprit. Most cases remit within 4 months after stopping the causative drugs. Stop causative drug and switch to an alternative if needed
• Anticholinergic drugs may be used but can worsen confusion
• Amantadine can also be used to treat drug-induced parkinsonism
• Consider using domperidone or ondansetron
• Consider olanzapine and risperidone as lower risk of PD

References

• Understanding drug-induced Parkinsonism. Neurology 2008;70;e32-e34
• Patient information leaflet