Extrapyramidal Side Effects From Medication

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Extrapyramidal side effects are a group of symptoms that can occur in people taking antipsychotic medications. They are more commonly caused by typical antipsychotics, but can and do occur with any type of antipsychotic. Antidepressants and other medications can sometimes cause extrapyramidal side effects as well.

Overview

Extrapyramidal function refers to our motor control and coordination, including being able to not make movements we don't want to make. Extrapyramidal side effects from medications are serious and may include:

  • Akathisia, which is a feeling of restlessness, making it hard to sit down or hold still. Symptoms include tapping your fingers, rocking, and crossing and uncrossing your legs.
  • Parkinsonism, which means you have the same symptoms as someone with Parkinson's disease, but your symptoms are caused by medications, not by the disease. These symptoms may include tremor, slower thought processes, slower movements, rigid muscles, difficulty speaking and facial stiffness.
  • Tardive dyskinesia, which is when you have uncontrollable facial movements such as sucking or chewing, lip-smacking, sticking your tongue out or blinking your eyes repeatedly.
  • Dystonia, which is when your muscles involuntarily contract and contort. This can lead to painful positions or movements. 

Diagnosis

The diagnosis of extrapyramidal symptoms often takes place when family members begin to notice that you are having difficulties. For this reason, it is important that the people close to you are aware of the potential for these effects and what to watch out for. 

During your evaluation, your doctor may want to speak to your family members about the type of symptoms they have observed. 

Treatment

Treatment of these symptoms depends upon the medication that induced them and which symptoms you have.

Your doctor may try decreasing your dose or switching your medication altogether to one that has been shown to have fewer extrapyramidal side effects.

Benzodiazepines are sometimes prescribed to help counteract extrapyramidal side effects, as are anti-parkinsonism drugs called anticholinergics. Antipsychotics block dopamine, which is what causes the extrapyramidal side effects in the first place. Anticholinergics increase dopamine so it becomes leveled out in your system.

Typical Antipsychotics

Typical antipsychotics are the first generation of antipsychotics and are more likely to have extrapyramidal side effects. The U.S. Food and Drug Administration (FDA) has approved these typical antipsychotics:

  • Thorazine (chlorpromazine)
  • Inapsine (droperidol)
  • Prolixin (fluphenazine)
  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Trilafon (perphenazine)
  • Orap (pimozide)
  • Compazine (prochlorperazine)
  • Navane (thiothixene)
  • Mellaril (thioridazine)
  • Stelazine (trifluoperazine)

Atypical Antipsychotics

Atypical antipsychotics are the newer second-generation of antipsychotics. If you are experiencing extrapyramidal side effects on one of the older, atypical antipsychotics, your doctor may switch you to one of these. FDA-approved atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Saphris (asenapine)
  • Clozaril (clozapine)
  • Fanapt (iloperidone)
  • Zyprexa (olanzapine)
  • Invega (paliperidone)
  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Geodon (ziprasidone)

Side Effects

Typical Antipsychotics

Beyond extrapyramidal side effects, these are the most common side effects of typical antipsychotics:

  • Drowsiness and feeling sleepy
  • Feeling agitated
  • Dry mouth
  • Blurred vision
  • Menstrual abnormalities
  • Hypotension, which is when your blood pressure suddenly drops
  • Sexual difficulties
  • Feeling like your mind has slowed down
  • Upset stomach
  • Diarrhea or constipation
  • Vomiting
  • Heartburn
  • Difficulty sleeping

These effects may go away in time, but if they don't or you find them bothersome, be sure to contact your doctor.

Atypical Antipsychotics

Other than extrapyramidal side effects, these are the most common side effects of atypical antipsychotics:

  • Constipation
  • Rash
  • Dizziness
  • Higher body temperature
  • Headache
  • Faster heartbeat
  • Drowsiness
  • Stuffy nose or a runny nose
  • Drooling
  • Difficulty sleeping
  • Problems urinating

These effects may go away in time, but if they don't or you find them bothersome, be sure to contact your doctor.

Pros and Cons of Discontinuing Your Medication

If you do experience extrapyramidal symptoms, you might wonder if you should stop taking your medication. If you are having such symptoms, you should start by talking to your doctor. Often the only way to address extrapyramidal effects is to try different drugs, to try lower doses of the medication, or to switch to another medication. 

Depending on what type of antipsychotic drug you are taking, your doctor may also prescribe other medications to help treat the extrapyramidal side effects.

Determining whether you continue your medication is often a process of weighing the benefits of the drug and the risks of no longer taking it against the severity and effects of your extrapyramidal. You may choose to live and cope with some side effects rather than risk losing the benefits of the medication. This is a decision that you should only make by talking to your doctor.

Never stop taking your medication or reduce your dosage on your own. Discontinuing your medication may cause symptoms of your condition to return or worsen. 

If your extrapyramidal symptoms are severe, you may work with your doctor to find another treatment option that will work for you.

A Word From Verywell

Discontinuing medication without consulting your doctor can lead to complications and side effects. If you are experiencing any troubling side effects from your medication, consult your doctor to discuss the next steps. Your doctor can recommend options that can treat and reduce extrapyramidal symptoms.

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Article Sources

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