Overview
Neuroleptic-induced tardive dyskinesia (TD) is a movement disorder that can occur in individuals exposed to dopamine receptor antagonists (DRAs) 1. Its clinical management presents a significant challenge 1.Diagnosis
TD is characterized by involuntary, repetitive movements, often affecting the orofacial region, but can also involve the trunk and extremities 1.
Diagnosis is primarily clinical, based on the presence of characteristic involuntary movements in a patient with a history of exposure to DRAs 1.Management
Pharmacological interventions are the primary approach to managing TD symptoms 1.
Several treatments have demonstrated efficacy in reducing TD symptoms compared to placebo, with large effect sizes 1.
Vesicular monoamine transporter 2 (VMAT2) inhibitors, such as valbenazine and deutetrabenazine, are specifically approved for the treatment of tardive dyskinesia 23.
Other agents that have shown efficacy include tetrabenazine, atypical antipsychotics (e.g., clozapine), and botulinum toxin 1.
Discontinuation or dose reduction of the offending DRA should be considered when feasible 1.Key Recommendations
Vesicular monoamine transporter 2 (VMAT2) inhibitors are recommended for the treatment of tardive dyskinesia 23. (Evidence: Strong)
Several pharmacological interventions have demonstrated efficacy in reducing TD symptoms compared to placebo 1. (Evidence: Strong)
Consider discontinuation or dose reduction of the offending dopamine receptor antagonist when clinically appropriate 1. (Evidence: Expert opinion)References
1 Solmi M, Fornaro M, Caiolo S, Lussignoli M, Caiazza C, De Prisco M et al.. Efficacy and acceptability of pharmacological interventions for tardive dyskinesia in people with schizophrenia or mood disorders: a systematic review and network meta-analysis. Molecular psychiatry 2025. link