What causes tardive dyskinesia?
Tardive dyskinesia — a nervous system disorder that causes repeated, uncontrolled movements — can be caused by ongoing use of any drug that blocks the reception of a chemical messenger in the brain called dopamine.
Most often, tardive dyskinesia is caused by long-term use of older types of antipsychotic (neuroleptic) drugs. These drugs are used to treat some mental health and other conditions, such as schizophrenia, bipolar disorder and dementia.
Long-term use of newer antipsychotic drugs and some other drugs used to treat nausea and vomiting also may cause tardive dyskinesia.
Older antipsychotic medications
Older antipsychotic drugs — sometimes called "typical," "first-generation" or "conventional" antipsychotics — that can cause tardive dyskinesia include:
- Chlorpromazine
- Fluphenazine
- Haloperidol
- Perphenazine
Newer antipsychotic medications
Although the risk is lower with newer antipsychotic drugs — sometimes called atypical or second-generation antipsychotics — they can also cause tardive dyskinesia.
- Higher risk. More research is needed, but the highest risk in this group seems to be with risperidone and paliperidone.
- Moderate risk. There may be a moderate risk with aripiprazole, lurasidone, olanzapine and ziprasidone, and a lower risk, yet, with iloperidone.
- Low or no risk. The lowest risk seems to be with pimavanserin, quetiapine and clozapine.
Anti-nausea medications
Ongoing use of the anti-nausea drug, metoclopramide, can also cause tardive dyskinesia. The Food and Drug Administration warns against using metoclopramide — used to treat nausea and help the stomach empty more quickly in adults — for more than 12 weeks. However, metoclopramide rarely causes tardive dyskinesia in children.
It's possible that ongoing use of some other anti-nausea drugs, such as prochlorperazine and chlorpromazine, also may cause tardive dyskinesia.
Other drugs
Some other drugs called anticholinergics — which include some antidepressants, antihistamines and other medications — may worsen the symptoms of tardive dyskinesia but don't actually cause it.
Monitoring is key
If you're taking a drug that may cause tardive dyskinesia on an ongoing basis, your doctor should regularly monitor you. Diagnosing and treating tardive dyskinesia early may help limit its effects.
June 04, 2019
- Tarsy D, et al. Tardive dyskinesia: Etiology, risk factors, clinical features, and diagnosis. https://www.uptodate.com/contents/search. Accessed April 8, 2019.
- Ferri FF. Tardive dyskinesia. In: Ferri's Clinical Advisor 2019. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed March 26, 2019.
- Mental health medications. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Accessed April 8, 2019.
- Tarsy D. Tardive dyskinesia: Prevention, prognosis, and treatment. https://www.uptodate.com/contents/search. Accessed April 9, 2019.
- AskMayoExpert. Schizophrenia. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- AskMayoExpert. Nausea and vomiting (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- Novick D, et al. Incidence of extrapyramidal symptoms and tardive dyskinesia in schizophrenia: Thirty-six-month results from the European schizophrenia outpatient health outcomes study. Journal of Clinical Psychopharmacology. 2010;30:531.