Why Do Antipsychotics Cause Tardive Dyskinesia?

Older antipsychotics are more likely to cause tardive dyskinesia than newer ones. They are also called typical antipsychotics or first-generation antipsychotics and are used to treat schizophrenia.

These drugs include:

• Haloperidol
• Chlorpromazine
• Loxapine
• Fluphenazine
• Perphenazine
• Pimozide
• Prochlorperazine
• Trifluoperazine
• Thiothixene

Besides the treatment of schizophrenia, first-generation antipsychotics are used for other conditions such as anxiety (trifluoperazine and prochlorperazine), Tourette’s syndrome (pimozide), and intractable hiccups, acute intermittent porphyria, and tetanus (chlorpromazine).

Yes, all antipsychotics can potentially cause tardive dyskinesia; however, the risk is lower with second-generation or atypical antipsychotics such as:

• Risperidone
• Ziprasidone 
• Olanzapine
• Quetiapine 
• Paliperidone
• Aripiprazole
• Lurasidone

Apart from schizophrenia treatment, atypical antipsychotics may be prescribed for other conditions such as bipolar disorder (olanzapine), autism (risperidone, aripiprazole), Tourette’s syndrome (aripiprazole), and depression (lurasidone).

Besides antipsychotics, other medications may cause tardive dyskinesia, such as:

• Antiemetics such as metoclopramide and prochlorperazine
• Antidepressants such as:
  • Selective serotonin reuptake inhibitors such as fluoxetine
  • Tricyclic antidepressants such as amitriptyline, doxepin, and imipramine
  • Monoamine oxidase inhibitors such as phenelzine
  • Serotonin receptor antagonists and reuptake inhibitors such as trazodone
• Antianxiety medications such as alprazolam
• Antiseizure medications such as phenytoin and phenobarbital
• Antimalarials such as chloroquine
• Mood stabilizers such as lithium
• Anti-Parkinson medications such as levodopa
• Antihistamines such as hydroxyzine
• Stimulants such as caffeine, amphetamine, and methylphenidate

Tardive dyskinesia may go away when detected and treated early. This may not happen in all cases, and some people continue to have the symptoms despite stopping the culprit medication.

In some people, symptoms may worsen with time. If symptoms of tardive dyskinesia do not go away despite stopping the medication responsible for causing it, the doctor may recommend medications to manage the symptoms. Moreover, this may be necessary in cases where stopping the medication is too risky for the affected person.

The U.S. Food and Drug Administration has approved two medications such as Ingrezza (valbenazine) and Austedo (deutetrabenazine) in 2017 for the treatment of tardive dyskinesia in adults. Other medications, typically benzodiazepines, may be given to manage the symptoms.

In resistant or severe cases, other therapeutic options such as Botox injections in the affected site or deep brain stimulation may be considered.