- Anticholinergic agents (benztropine and diphenhydramine)
- Benzodiazepines.

Rutgers University

Drug-induced movement disorders (DIMDs) can reduce the quality of life, decrease drug adherence, and cause compromised performance of motor skills. 
Parkinsonism, akathisia, tardive syndrome, and acute dystonia are associated with DIMDs. 

Movement Disorders

Lane RJ, Routledge PA. Drug-induced neurological disorders. Drugs. 1983;26(2):124-147. doi:10.2165/00003495-198326020-00002



Drug-Induced Neurologic Conditions

- Described as a feeling of restlessness with an absolute need to move
- Symptoms may improve at rest but forced restraint does not reduce the symptoms.
- May be seen within the few first months of treatment

Akathisia 

- EPS or extrapyramidal symptoms include parkinsonism
- EPS includes dystonia (muscle spasms and contractions), akathisia (restlessness)
- Parkinsonism includes rigidity, bradykinesia (slow movements) and tremor
- Estimated that 1/3 to 1/2 of parkinsonism cases may be caused by drugs
- Can be caused by neuroleptic agents, antidepressants and antipsychotics (newer atypical antipsychotics have been promoted as causing fewer EPS)

EPS and Parkinsonism

- Permanent abnormal involuntary movements that have a delayed onset
- Involves the tongue, face, and jaw
- May occur years after the drug is withdrawn

Tardive Syndromes

- Can occur with the first dose of an offending agent
- May be associated with distress and pain, difficulty moving, breathing, and swallowing

Acute Dystonia 

- Dopamine-receptor blockers (antipsychotics)
- Antiemetics (metoclopramide)


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