Treating and Managing Tardive Dyskinesia

Tardive dyskinesia (TD) is a movement disorder caused by certain medicines. People with TD have involuntary facial movements, or tics. “Tardive” means delayed, and “dyskinesia” means involuntary muscle movements. There is often a long delay between starting a medicine and developing TD symptoms.^1-3

Several medicines that treat Parkinson’s disease can cause TD. Drugs used to treat bipolar disorder, schizophrenia, and other mood disorders can also cause TD. Talk to your doctor about your risk of TD. They can discuss symptoms to monitor and how to manage the condition.^1,3,4

What causes tardive dyskinesia?

Long-term use of certain medicines causes TD. These medicines include those that treat some:¹

• Mood disorders and mental health conditions
• Stomach problems
• Neurological conditions

Specific drugs that can cause TD include:^2-4

• First-generation antipsychotics (neuroleptics) – chlorpromazine, fluphenazine, Haldol® (haloperidol), and others
• Second-generation antipsychotics – Abilify® (aripiprazole), Saphris® (asenapine), Rexulti® (brexpiprazole), and others
• Antiemetics (anti-nausea drugs) – Reglan® (metoclopramide)
• Antidepressants – amitriptyline, Prozac® (fluoxetine), Nardil® (phenelzine), and others
• Levodopa-containing drugs for Parkinson’s disease – Sinemet® (levodopa-carbidopa) and others
• Anti-seizure drugs – phenobarbital, Dilantin® (phenytoin)

First-generation antipsychotics have the highest risk of causing TD. These are drugs used to treat schizophrenia, bipolar disorder, and other mood disorders. About 1 in 4 people who take antipsychotics develop TD. Second-generation antipsychotics have a lower risk of causing TD.^1-4

Antipsychotics and antiemetics are dopamine antagonists. Dopamine is a brain chemical that activates proteins called receptors to activate body movements. Dopamine antagonists block these receptors. Long-term dopamine receptor blocking causes the number of dopamine receptors in your body to increase. This can make you more sensitive to dopamine, which can lead to TD.^2,5

What are the risk factors for tardive dyskinesia?

Experts do not know why some people develop TD while others do not. People of any age can develop TD. Older adults, women, and Black people have a higher risk.^1-3

Certain health conditions increase your risk of developing TD. These conditions include:^1,3

• Diabetes
• Human immunodeficiency virus (HIV)
• Substance use disorder
• Traumatic brain injury (TBI)

What are the symptoms of tardive dyskinesia?

Most people with TD have mild symptoms. But symptoms can worsen over time. They can also be triggered by stress.^1-4

The most common symptoms of TD are repetitive and involuntary facial movements. People with TD may not notice these movements, which may include:^1-4

• Rapid blinking
• Chewing motions
• Grimacing or frowning
• Smacking lips
• Making sucking motions
• Sticking out your tongue

Symptoms can affect other body parts too. These symptoms include:¹

• Finger movements
• Crossing and uncrossing the arms and legs
• Thrusting or rocking the pelvis
• Walking with a duck-like gait

Symptoms usually develop after months or years of taking a drug that causes TD. Symptoms usually go away after stopping the drug or lowering the dose. But some people have symptoms that last after stopping the drug. Talk to your doctor before changing or stopping your medicines.^1-3

How is tardive dyskinesia diagnosed?

If you are taking medicines that can cause TD, your doctor will monitor you for symptoms. Symptoms can look similar to symptoms of other movement conditions, such as Parkinson’s disease. But certain tests can help diagnose TD, such as:^1,2

• Physical exam to test nerve function
• Blood and urine tests for infections and other problems
• Electroencephalogram (EEG) to test brain activity
• Electromyography (EMG) to test communication between muscles and nerves

How is tardive dyskinesia managed and treated?

Managing TD can help reduce the risk of other complications, which can include various emotional and physical challenges. Symptoms of TD often lead to feelings of self-consciousness. This may cause you to withdraw from other people. This can affect your relationships and ability to work. In rare cases, TD can lead to severe problems with breathing or swallowing.¹

The first step in managing TD is to reduce the dose of the medicine causing TD. If symptoms continue, your doctor may switch you to a different type of medicine.^1,3,6

Some people still have TD symptoms after changing medicines. If symptoms continue, your doctor may suggest treatments for TD. Treatments may include:^1,3,6

• Medicines like Ingrezza® (valbenazine), Xenazine® (tetrabenazine), or Austedo® (deutetrabenazine)
• Botox® (botulinum toxin) injections
• Deep brain stimulation

The 3 medicines listed above work by blocking a protein called VMAT2. This protein is involved in storing and releasing dopamine. Blocking VMAT2 reduces involuntary movements. Valbenazine and deutetrabenazine are preferred over tetrabenazine. There is limited evidence of other treatments working to treat TD.^3,6

Talk to your doctor about other ways to manage TD, which may involve:³

• Talking about other medicines that may worsen TD
• Getting symptom assessments every few months
• Getting regular exercise
• Quitting smoking and avoiding substance use
• Managing blood sugar levels with a balanced diet

Before beginning treatment for tardive dyskinesia, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.