Management of Tardive Dyskinesia

Introduction to Tardive Dyskinesia Management

The American Academy of Family Physicians recommends avoiding benztropine or trihexyphenidyl when extrapyramidal symptoms occur in elderly patients on typical antipsychotics, which extends to tardive dyskinesia management where anticholinergics can worsen the involuntary movements 1
Clinical guidelines suggest that anticholinergics should not be used to treat tardive dyskinesia and may actually worsen the condition, as stated by the American family physician 1

The American Academy of Family Physicians and other guideline societies emphasize the importance of distinguishing between drug-induced parkinsonism and tardive dyskinesia, as anticholinergics may be beneficial for the former but worsen the latter 1, 2

The American Academy of Family Physicians guidelines explicitly recommend avoiding benztropine or trihexyphenidyl when extrapyramidal symptoms occur in elderly patients on typical antipsychotics 3

Gradually withdraw the offending antipsychotic if clinically feasible, as recommended by clinical guidelines 4
Switch to atypical antipsychotics with lower D2 affinity if continued antipsychotic treatment is necessary, based on clinical evidence 5
Use FDA-approved VMAT2 inhibitors (valbenazine or deutetrabenazine) for TD treatment, as supported by clinical guidelines 4

The American Academy of Child and Adolescent Psychiatry warns that in patients with mental disorders on neuroleptics, antiparkinsonian drugs can precipitate toxic psychosis and may intensify mental symptoms, particularly at the beginning of treatment or with dosage increases 6

For tardive dyskinesia specifically, first-line treatment includes the use of FDA-approved VMAT2 inhibitors (valbenazine or deutetrabenazine) 6