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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.
Many patients will not develop these side effects, although there is still a significant possibility of risks associated with Antipsychotic usage. The percentage of patients affected by side effects like Tardive dyskinesia is significantly high and estimated to be a 20-50% prevalence. [1] [2]
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 .
As haloperidol is a high-potency typical antipsychotic, it tends to produce significant extrapyramidal side effects. According to a 2013 meta-analysis of the comparative efficacy and tolerability of 15 antipsychotic drugs it was the most prone of the 15 for causing extrapyramidal side effects. [29]
Perospirone † – Has a higher incidence of extrapyramidal side effects than other atypical antipsychotics. [165] Risperidone (Risperdal) – Divided dosing is recommended until initial titration is completed, at which time the drug can be administered once daily. Used off-label to treat Tourette syndrome and anxiety disorder.
Common adverse effects of olanzapine, occurring from 1–10%, include: Gynecomastia [8] Extrapyramidal symptoms (EPS) (dose-dependent). Tends to produce less extrapyramidal side effects than typical antipsychotics but more extrapyramidal side effects than sertindole, clozapine and quetiapine. [9] [10]
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