Medications That Cause Parkinson's Symptoms
Primary Offending Drug Classes
- High-potency typical antipsychotics like haloperidol and antiemetics like metoclopramide pose the greatest risk for drug-induced parkinsonism, according to the American Academy of Child and Adolescent Psychiatry 1, 2
- Typical antipsychotics, including high-potency agents such as haloperidol, perphenazine, pimozide, fluphenazine, and trifluoperazine, carry the greatest risk for extrapyramidal symptoms 1, 2
- Atypical antipsychotics have a lower risk than typical antipsychotics but can still cause parkinsonism, as noted by Praxis Medical Insights 3
- Atypical antipsychotics, including olanzapine, asenapine, clozapine, and lurasidone, are associated with a lower risk of parkinsonism 4
Risk Factors
- Children and adolescents may have a higher risk for extrapyramidal symptoms than adults, according to the American Academy of Child and Adolescent Psychiatry 1, 2
Management Approach
- The American Academy of Child and Adolescent Psychiatry recommends discontinuing the offending medication if clinically feasible, as symptoms completely resolve in most patients after drug withdrawal 1, 2
- Anticholinergic agents, such as benztropine and trihexyphenidyl, are first-line treatments for younger patients with drug-induced parkinsonism, as recommended by the American Academy of Child and Adolescent Psychiatry 1
- Amantadine is better tolerated in elderly patients with similar efficacy to anticholinergic agents, according to the American Academy of Child and Adolescent Psychiatry 1
- For patients with Parkinson's disease requiring antipsychotics, the American Geriatrics Society recommends using quetiapine, clozapine, or pimavanserin 6
Critical Pitfalls to Avoid
- The American Academy of Child and Adolescent Psychiatry advises against mistaking drug-induced parkinsonism for worsening of underlying psychiatric illness or negative symptoms of schizophrenia 1, 2
- Prophylactic antiparkinsonian agents should not be routinely prescribed except in high-risk patients, as recommended by the American Academy of Child and Adolescent Psychiatry 1, 2
- Valproic acid and other anticonvulsants may be associated with a lower risk of parkinsonism, as noted in Pediatrics 5