Drug-induced parkinsonism: diagnosis and management

Figures & data

Table 1 Patient-related risk factors for DIP

Risk factors	References
Aging	1,3,15,18,22,23
Female sex	15,16,18,25–28
Preexisting extrapyramidal disorder	29
Brain damage and atrophy	30
Dementia	29,31
HIV infection	32
Severe psychiatric disease	33
Severe unexplained hyposmia	34,35
History of familial parkinsonism	36

Abbreviation: DIP, drug-induced parkinsonism.

Table 2 Offending agents causing DIP

Class	Drugs	Risk
Conventional antipsychotics	Phenothiazines	High
	Chlorpromazine
	Levomepromazine
	Thioridazine
	Perphenazine
	Fluphenazine
	Thioxanthenes
	Flupentixol
	Thiothixene
	Zuclopenthixol
	Diphenylbutylpiperidines
	Pimozide
	Dibenzoxazepines
	Loxapine
	Amoxapine
	Butyrophenones
	Haloperidol
Atypical antipsychotics	Thienobenzodiazepine	High
	Olanzapine
	Pyridopyrimidine
	Risperidone
	Dibenzothiepine
	Zotepine
	N-arylpiperazine
	Aripiprazole
	Quetiapine (low-to-moderate dosage)	Low
	Clozapine (low-to-moderate dosage)	Low
Neuroleptics	Phenothiazine derivatives	Intermediate to high
	Prochlorperazine
	Promethazine
	First-generation H1 antihistamines (hydroxyzine, alimemazine, aceprometazine)
	Benzamide substitutes
	Metoclopramide
	Sulpiride
	Tiapride
	Cisapride
	Clebopride
	Veralipride
Nonneuroleptics
Gastroprokinetic	Heteroarylpiperidine	Low
	Domperidone
Monoamine depleters	Tetrabenazine Reserpine	High
Sympatholytic (l-tyrosine derivative)	Methyldopa	High
Calcium channel antagonists	Flunarizine, cinnarizine	High
	Diltiazem, verapamil	Low
Antidepressants	Tricyclics	Intermediate
	Imipramine
	Amitryptiline
	Clomipramine
	Dosulepin
	Selective serotonin reuptake inhibitors	Intermediate
	Serotonin norepinephrine reuptake inhibitors	Intermediate
	Monoamine oxidase inhibitors	Low
	Moclobemide
	Phenelzine
Inorganic ion	Lithium	Intermediate
Anticonvulsants	Valproic acid	Intermediate
	Phenytoin
Miscellaneous	Antiarrhythmics	Low
	Amiodarone
	Procaine
	Immunosuppressants
	Cyclosporine A
	Acetylcholinesterase inhibitors
	Chemotherapeutic agents
	Thalidomide
	Antibiotics
	Rifampicin
	Antiviral (acyclovir, vidarabine, antiretrovirals)
	Antifungal (amphotericin B)
	Hormones
	Thyroxine

Abbreviation: DIP, drug-induced parkinsonism.