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| LETTER TO EDITOR |
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| Year : 2011 | Volume
: 43
| Issue : 1 | Page : 93 |
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Tardive dyskinesia with clozapine dose reduction or withdrawal dyskinesia?
Samir Kumar Praharaj
Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
| Date of Web Publication | 15-Jan-2011 |
Correspondence Address:
Samir Kumar Praharaj
Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0253-7613.75686
How to cite this article:
Praharaj SK. Tardive dyskinesia with clozapine dose reduction or withdrawal dyskinesia?. Indian J Pharmacol 2011;43:93 |
Sir,
Shrivastava et al.[1] have reported an improvement of tardive dyskinesia (TD) with addition of clozapine that exacerbated with its dose reduction (from 200 to 150 mg/day). The patient had developed TD [score 7 on abnormal involuntary movement scale (AIMS)] while being treated with depot fluphenazine injection. It should be noted that the effect of depot injection lasts for a long period and its elimination half-life is longer than that of oral preparations. [2] Thus, it is possible that the index case might have developed withdrawal dyskinesia because of decrease in serum levels of fluphenazine [3] , and not clozapine, which has lower affinity for D 2 receptors. There are even case reports of TD induced or worsened by clozapine therapy. [4],[5],[6] Nevertheless, clozapine still remains a viable treatment option for antipsychotic-induced TD, [7] as well as withdrawal dyskinesias, [8] as a maintenance treatment for long periods. [9]
TD was originally caused by fluphenazine. With clozapine (200 mg) treatment for 1 month, symptoms of TD were reduced, and when the dose of clozapine was decreased to 150 mg, symptoms reemerged. Half-life of fluphenazine deconate i.m., which the patient was receiving, is 6-9 days and under multiple dosing, the mean elimination half-life is increased to 14 days. [1] In our case, symptoms of TD reduced after 2 weeks.
Clozapine can improve or worsen TD, and we observed it to improve. The patient is presently maintained on clozapine 200 mg/day without any reemergence of symptoms for last 20 months.
| » References | |  |
| 1. | Shrivastava M, Solanke B, Dakhale G, Somani A, Waradkar P. Relapse of tardive dyskinesia due to reduction in clozapine dose. Indian J Pharmacol 2009;41:201-2. 
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| 2. | Jann MW, Ereshefsky L, Saklad SR. Clinical pharmacokinetics of the depot antipsychotics. Clin Pharmacokinet 1985;10:315-33.
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| 3. | Wistedt B, Wiles D, Jψrgensen A. A depot neuroleptic withdrawal study neurological effects. Psychopharmacology (Berl) 1983;80:101-5.
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| 4. | Ertugrul A, Demir B. Clozapine-induced tardive dyskinesia: A case report. Prog Neuropsychopharmacol Biol Psychiatry 2005;29:633-5.
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| 5. | Raguraman J, Vijaysagar J. Worsening of tardive dyskinesia due to clozapine therapy. J Postgrad Med 2007;53:218.
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| 6. | Li CR, Chung YC, Park TW, Yang JC, Kim KW, Lee KH, et al. Clozapine-induced tardive dyskinesia in schizophrenic patients taking clozapine as a first-line antipsychotic drug. World J Biol Psychiatry 2009;10:919-24.
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| 7. | Margolese HC, Chouinard G, Kolivakis TT, Beauclair L, Miller R, Annable L. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 2: Incidence and management strategies in patients with schizophrenia. Can J Psychiatry 2005; 50: 703-14.
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| 8. | Mendhekar DN, Inamdar A. Withdrawal-emergent respiratory dyskinesia with risperidone treated with clozapine. J Neuropsychiatry Clin Neurosci 2010; 22: E24.
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| 9. | Louzγ MR, Bassitt DP. Maintenance treatment of severe tardive dyskinesia with clozapine: 5 years' follow-up. J Clin Psychopharmacol 2005;25:180-2.
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| This article has been cited by | | 1 |
Clozapine research from India: A Systematic Review |
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| Sandeep Grover, Sanjana Kathiravan | | Asian Journal of Psychiatry. 2022; : 103353 | | [Pubmed] | [DOI] | | | 2 |
Delirium after abrupt discontinuation of clozapnie |
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| Devavrat Harshe, Parth Nagda, Sneha Gore | | Asian Journal of Psychiatry. 2020; 53: 102235 | | [Pubmed] | [DOI] | |
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