Propranolol (inderal) for tardive dyskinesia and extrapyramidal side effects from neuroleptics: Possible involvement of beat - adrenergic mechanisms

• 1.

  1. This clinical report describes four psychotic patients with neuroleptic-induced tardive (orofacial) dyskinesia and extrapyramidal side effects who were successfully treated with propranolol 30 – 60 mg per day.

• 2.

  2. Relief of orofacial symptoms and tremor was marked and rapid (one to ten days). In one case propranolol was stopped and orofacial symptoms emerged.

• 3.

  3. No side effects were observed.

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  4. The literature on propranolol in tardive dyskinesia and tremor disorders is reviewed. Central and peripheral mechanisms are considered, and several specific experiments are proposed to clarify the site of action. It is suggested that clinical investigation with propranolol in tardive dyskinesia and extrapyramidal side effects might enhance our understanding of the possible adrenergic modulation of the dopaminergic/cholinergic balance in the striatum.