Treatment of Troublesome Tardive Dyskinesia (At Least Moderate) in Patients With an Approved Antipsychotic Indication

Patients receiving antipsychotics for an approved indication who develop tardive dyskinesia that is at least moderate in severity — and that meaningfully interferes with activities of daily living and quality of life — require structured, active clinical management.

Clinical Scenario

Tardive dyskinesia at least moderate in severity, with functional impact on activities of daily living and quality of life, occurring in a patient with an ongoing approved antipsychotic indication. Current guidelines specify that suppressive therapy should be considered when disability reaches this threshold.

Treatment Approach

Second-line suppressive therapy is the approach in this setting — specific oral agents are recommended for eligible patients, with agent selection criteria and dose-titration guidance defined in the complete structured protocol.

Instant Access to Structured Evidence-Based Regimens

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.

In those who cannot tolerate or fail Deut-TBZ or valbenazine, clonazepam or gingko biloba can be considered as alternatives.

Clonazepam should be initiated at 0.5 mg and titrated slowly, not exceeding 4.5 mg daily.

Ginkgo biloba extract (EGb-761) dosage is recommended at 240 mg once daily.

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