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Medications are used to reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs, by either directly or indirectly increasing dopaminergic neurotransmission. The treatment varies by the type of the EPS, but may involve anticholinergic agents such as procyclidine, benztropine, diphenhydramine, and trihexyphenidyl.
Dopamine receptors (subtypes D 1, D 2, D 3 and D 4), which account for its different antipsychotic properties on productive and unproductive symptoms, in the mesolimbic dopamine system accounts for the antipsychotic effect whereas the blockade in the nigrostriatal system produces the extrapyramidal effects
These drugs are not only dopamine antagonists at the receptor specified, but also act on serotonin receptor 5HT 2A. [15] [1] These drugs have fewer extrapyramidal side effects and are less likely to affect prolactin levels when compared to typical antipsychotics. [11]
Sedation is very common, and extrapyramidal side effects are common and include restlessness, dystonic reactions, pseudoparkinsonism, and akathisia; the extrapyramidal symptoms can affect 2% of people at low doses, whereas higher doses may affect as many as 40% of people.
Anticholinergic drugs are used to treat a variety of conditions: Dizziness (including vertigo and motion sickness-related symptoms) Extrapyramidal symptoms, a potential side-effect of antipsychotic medications; Gastrointestinal disorders (e.g., peptic ulcers, diarrhea, pyloro spasm, diverticulitis, ulcerative colitis, nausea, and vomiting)
more extrapyramidal side effects (EPS) and less antihistaminic effects (e.g. sedation), alpha adrenergic antagonism (e.g. orthostatic hypotension), and anticholinergic effects (e.g. dry mouth) middle: perphenazine and loxapine: intermediate D2 affinity, with more off-target effects than high-potency agents low: chlorpromazine
Atypical antipsychotic drugs have a similar blocking effect on D 2 receptors; however, most also act on serotonin receptors, especially 5-HT 2A and 5-HT 2C receptors. Both clozapine and quetiapine appear to bind just long enough to elicit antipsychotic effects but not long enough to induce extrapyramidal side effects and prolactin hypersecretion.
Biperiden is also commonly used to improve acute extrapyramidal side effects related to antipsychotic drug therapy, such as akathisia. It relieves muscle rigidity , reduces abnormal sweating related with clozapine and methadone use [ 9 ] [ 10 ] and salivation , improves abnormal gait , and to lesser extent, tremor .