An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-03-19 DOI:10.1007/s40263-024-01078-z
Nora Vanegas-Arroyave, Stanley N. Caroff, Leslie Citrome, Jovita Crasta, Roger S. McIntyre, Jonathan M. Meyer, Amita Patel, J. Michael Smith, Khody Farahmand, Rachel Manahan, Leslie Lundt, Samantha A. Cicero
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Abstract

Drug-induced movement disorders (DIMDs) are associated with use of dopamine receptor blocking agents (DRBAs), including antipsychotics. The most common forms are drug-induced parkinsonism (DIP), dystonia, akathisia, and tardive dyskinesia (TD). Although rare, neuroleptic malignant syndrome (NMS) is a potentially life-threatening consequence of DRBA exposure. Recommendations for anticholinergic use in patients with DIMDs were developed on the basis of a roundtable discussion with healthcare professionals with extensive expertise in DIMD management, along with a comprehensive literature review. The roundtable agreed that “extrapyramidal symptoms” is a non-specific term that encompasses a range of abnormal movements. As such, it contributes to a misconception that all DIMDs can be treated in the same way, potentially leading to the misuse and overprescribing of anticholinergics. DIMDs are neurobiologically and clinically distinct, with different treatment paradigms and varying levels of evidence for anticholinergic use. Whereas evidence indicates anticholinergics can be effective for DIP and dystonia, they are not recommended for TD, akathisia, or NMS; nor are they supported for preventing DIMDs except in individuals at high risk for acute dystonia. Anticholinergics may induce serious peripheral adverse effects (e.g., urinary retention) and central effects (e.g., impaired cognition), all of which can be highly concerning especially in older adults. Appropriate use of anticholinergics therefore requires careful consideration of the evidence for efficacy (e.g., supportive for DIP but not TD) and the risks for serious adverse events. If used, anticholinergic medications should be prescribed at the lowest effective dose and for limited periods of time. When discontinued, they should be tapered gradually.

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基于证据的关于抗胆碱能药物用于治疗药物诱发的运动障碍的最新进展
药物诱发运动障碍(DIMDs)与多巴胺受体阻断剂(DRBAs)(包括抗精神病药物)的使用有关。最常见的形式是药物诱发帕金森氏症(DIP)、肌张力障碍、肌张力障碍和迟发性运动障碍(TD)。神经性恶性综合征(NMS)虽然罕见,但接触 DRBA 后可能会危及生命。抗胆碱能药物在 DIMD 患者中的使用建议是在与具有丰富 DIMD 治疗专业知识的医护人员进行圆桌讨论的基础上,结合全面的文献综述制定的。圆桌会议一致认为,"锥体外系症状 "是一个非特异性术语,包含一系列异常运动。因此,它造成了一种误解,即所有 DIMD 都可以用同样的方法进行治疗,从而可能导致抗胆碱能药物的滥用和过量处方。多发性肌张力障碍在神经生物学和临床上各不相同,治疗范例也各不相同,使用抗胆碱能药物的证据水平也各不相同。有证据表明,抗胆碱能药物对 DIP 和肌张力障碍有效,但不推荐用于治疗 TD、肌张力障碍或 NMS;除急性肌张力障碍高危人群外,也不支持使用抗胆碱能药物预防 DIMD。抗胆碱能药物可能会引起严重的外周不良反应(如尿潴留)和中枢效应(如认知功能受损),所有这些都会引起高度关注,尤其是对老年人而言。因此,适当使用抗胆碱能药物需要仔细考虑疗效证据(例如,支持治疗 DIP,但不支持治疗 TD)和严重不良反应的风险。如果使用抗胆碱能药物,应按最低有效剂量并在有限的时间内使用。停药时,应逐渐减量。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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