Nonantipsychotic Catecholaminergic Drugs for Antipsychoticinduced Tardive Dyskinesia

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 261 subjects with tardive dyskinesia (TD). Patients were mostly chronically mentally ill inpatients in their 50s, and studies were primarily of short (2 to 6 weeks) duration. One 3-arm trial (n=20) found that both alpha-methyldopa (RR 0.33, 95% CI 0.14 to 0.80) and reserpine (RR 0.52 95% CI 0.29 to 0.96) may lead to a clinically important improvement in TD symptoms vs. placebo after 2 weeks' treatment, but found no evidence of a difference between them (RR 0.60, 95% CI 0.19 to 1.86). Another trial (n=13) compared tetrabenazine and haloperidol after 18 weeks' treatment and found no difference on clinically important improvement in TD symptoms (RR 0.93, 95% CI 0.45 to 1.95). For remaining outcomes there was no evidence of a difference between any of the interventions: alpha-methyldopa vs. placebo for deterioration of TD symptoms (RR 0.33, 95% CI 0.02 to 7.32; 1 RCT; n = 20), celiprolol vs. placebo for leaving the study early (RR 5.28, 95% CI 0.27 to 102.58; 1 RCT; n = 35) and quality of life (RR 0.87, 95% CI 0.68 to 1.12), alpha-methyldopa vs. reserpine for deterioration of TD symptoms (1 RCT; n = 20; not estimable, no reported events), reserpine or carbidopa/levodopa vs. placebo for deterioration of TD symptoms (RR 1.18, 95% CI 0.35 to 3.99; 2 RCTs; n = 37), oxypertine vs. placebo for deterioration of mental state (RR 2.20, 95% CI 0.22 to 22.45; 1 RCT; n = 42), dopaminergic drugs (amantadine, bromocriptine, tiapride, oxypertine, carbidopa/levodopa) vs. placebo for leaving the study early (RR 1.29, 95% CI 0.65 to 2.54; 6 RCTs; n = 163), and tetrabenazine vs. haloperidol for deterioration of TD symptoms (RR 1.17, 95% CI 0.09 to 14.92; 1 RCT; n = 13) and leaving the study early (RR 0.23, 95% CI 0.01 to 4.00).