Treatment of Troublesome Tardive Dyskinesia in Patients on Antipsychotics for an Approved Indication

This protocol applies when a patient receiving antipsychotic therapy for an approved clinical indication develops tardive dyskinesia that is at least moderate in severity — disrupting activities of daily living and reducing quality of life.

The defining clinical situation: troublesome tardive dyskinesia, at minimum moderate severity, with functional impact sufficient to interfere with daily activities and quality of life — in a patient who has a legitimate, ongoing indication for antipsychotic use. Suppressive therapy warrants consideration at this threshold of disability.

Management centres in part on careful review of the antipsychotic regimen itself. The complete protocol describes how to balance adequate control of the underlying psychiatric condition against the burden of tardive dyskinesia — including what to consider when initial measures are insufficient.

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References

DOI: 10.1016/j.jns.2018.02.010

In patients with troublesome TS, suppressive agents should be considered.
Suppressive therapy should be considered when disabilities are at least moderate and interfere with ADLs and QoL, with new VMAT2 inhibitors or TBZ (if both Deut-TBZ and valbenazine are not available) as the first-line treatment, with clonazepam and Ginkgo biloba as second-line, and combined with amantadine if symptoms are still troublesome.
Therefore, it seems reasonable for physicians to prescribe the lowest antipsychotic dosage that can control an individual's psychotic symptoms.

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