Drug Induced Parkinsonism

Parkinsonism and Medications

Certain medications have side effects that look like the same physical (and mental) symptoms of Parkinson's Disease. When Parkinson’s is caused by medications, it's referred to as "drug-induced parkinsonism." Parkinsonism caused by antipsychotic (neuroleptic) medication and is sometimes referred to as neuroleptic-induced Parkinsonism."

The types of medications most likely to have this effect include some types of anti-nausea and antipsychotic drugs. These medications block the dopamine receptors in nerve cells. This is serious and this results in the reduction of dopamine levels causing "Parkinsonism."

When someone stops taking these medications, hopefully the symptoms of Parkinsonism decrease over time, but that certainly isn't guaranteed.

Parkinsonism isn’t the exact same as Parkinson’s disease, although it is frequently mistaken for it, even by your expert medical professionals, neurologist and movement specialist. Continue to read to learn more about the similarities and differences between drug-induced parkinsonism and Parkinson’s disease. Regardless, you certainly wouldn't want to take Parkinson's medications to treat the symptoms and side effects of another medication!

Signs and symptoms

The symptoms of drug-induced Parkinsonism are very similar to the same physical symptoms caused by Parkinson’s disease and in fact can be indistinguishable and more than likely you will still be recommended Parkinson's medication as your primary form of treatment from your Neurologist and/or movement specialist.

What are the causes?

Drug-induced Parkinsonism is caused by medications that reduce dopamine levels in the brain. Dopamine is a neurotransmitter that works to control bodily movements and is part of the brain’s reward system that helps you feel pleasure and enjoyment, and it supports your ability to learn and focus.

Medications that bind to and block dopamine receptors are called dopamine antagonists. These medications aren’t used to treat Parkinson’s disease. Rather, they’re used to treat other conditions that might seriously impact your quality of life.

If your doctor has prescribed a medication that causes unwanted side effects, you may have options, but taking more and more medications like Carbidopa-Levodopa may not be the smartest option.

Some medications that cause drug-induced parkinsonism include:

Antipsychotics

Antipsychotic medications are used to treat several disorders, including:

schizophrenia
bipolar disorder
Alzheimer's disease
Tourette syndrome
anxiety disorders
depression

They’re used to reduce or alleviate symptoms such as delusions and hallucinations.

Some antipsychotics that might cause parkinsonism include:

fluphenazine
chlorpromazine
promazine
pimozide
haloperidol
perphenazine

Anti-nausea medication

Some medications used to treat motion sickness, nausea, and vertigo block dopamine receptors and can cause parkinsonism. They include antihistamines such as:

hydroxyzine
promethazine

Gastrointestinal prokinetics

Gastric motility disorders are digestive conditions that occur when the nerves or muscles in the gut don’t function in a coordinated manner. Some medications used to treat this condition can cause parkinsonism as a side effect. They include:

metoclopramide
prochlorperazine
levosulpiride

Calcium channel blockers

Calcium channel blockers are used to treat cardiovascular conditions such as high blood pressure and chest pain. They’re also used to treat neurological disorders. In some instances, calcium channel blockers may cause movement disorders and parkinsonism.

Anticonvulsant medication

Valproate, an antiseizure drug used to treat epileptic seizures and convulsions is the type of medication in this class most likely to cause parkinsonism.

Antidepressants

Serotonin reuptake inhibitors (SSRI's) are widely used as antidepressants and mood stabilizers. These medications may cause or worsen parkinsonism in some instances.

Serotonin-norepinephrine reuptake inhibitors (SNRI's)another form of antidepressant, may also have this effect. SNRIs are used to treat major depressive disorders, ADHD, fibromyalgia, and other conditions.

Exposure to toxins

Extensive or long-term exposure to environmental toxins is another potential cause of parkinsonism. It’s thought that these chemicals cause oxidative stress or mitochondrial dysfunction, which can lead to movement disorders.

Some toxins, including certain pesticides, may also pose a risk for Parkinson’s disease.

Pesticides to avoid include:

Paraquat / RoundUp
rotenone

Parkinsonism vs. Parkinson’s disease

Parkinsonism refers to a cluster of symptoms that mimic the movement problems caused by Parkinson’s disease. It’s sometimes referred to as atypical Parkinson's disease, secondary parkinsonism, or Parkinson’s plus.

Parkinson’s disease is a chronic, neurodegenerative brain disorder. In addition to problems with movement, Parkinson’s disease causes non-motor symptoms that aren’t caused by drug-induced parkinsonism. They include:

depression
problems with sleep
constipation
anosmia (loss of smell)

Another key difference between drug-induced parkinsonism and Parkinson’s disease is symmetry. Drug-induced parkinsonism usually affects both sides of the body equally. Parkinson’s disease affects one side of the body more than the other.

Parkinsonism can be caused by medications, repeated head trauma, and environmental toxins. It can also be caused by neurological disorders, including Parkinson’s disease. Other neurological conditions that cause parkinsonism include:

progressive supranuclear palsy
multiple system atrophy (ALS)
vascular parkinsonism
Lewy body dementia
corticobasal degeneration

Parkinsonism caused by neurological conditions typically includes the early onset of some symptoms that manifest later in Parkinson’s disease. They include:

falling
dementia
hallucinations

Drug-induced tremor vs. drug-induced parkinsonism

Drug-induced parkinsonism usually causes resting tremors. Tremors are rhythmic, involuntary movements you’re unable to stop or control. They can take on the appearance of twitching, shaking, or quivering. A resting tremor occurs when a limb is at rest and stops when it’s in use.

Common parts of the body where drug-induced parkinsonism may cause resting tremors includes:

fingers
hands
jaw
feet

Tremors can also be caused by drugs that don’t typically cause drug-induced parkinsonism. They include:

beta-adrenergic agonists
lithium
amiodarone

These medications don’t cause resting tremors. Rather, they cause:

Action tremors. These occur in a body part that’s moving, not a body part that’s resting.
Postural tremors. These occur when a body part is forced to withstand gravity, such as when arms are outstretched or legs are raised.

Is drug-induced parkinsonism reversible?

Drug-induced parkinsonism is usually be reversed once the medication at fault is eliminated. Results aren’t immediate, though and it's recommended you have a game plan or a Plan of Action to get you back to normal before these side effects completely ruin your life.

In some instances, parkinsonism may persist and progress. When this occurs, it’s most likely because the person already had or was starting to have a dopamine deficit not associated with the medication. Parkinsonism doesn’t cause Parkinson’s disease, but it may accelerate this condition in a person who was going to get it.

Outlook

Parkinsonism consists of a cluster of symptoms that resemble the physical symptoms of Parkinson’s disease. Drug-induced parkinsonism may be caused by certain prescription medications, including specific anti-nausea drugs and several antipsychotic drugs.

Drug-induced parkinsonism is usually reversible. Treatment involves elimination of these medications that caused the symptoms. Even after stopping these medications your symptoms may persist for years and require an alternative to Parkinson's medications.

When you're ready

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