Drugs that Cause Movement Disorders

Most of us learned in our professional training that neuroleptic agents cause movement disorders, or extrapyramidal symptoms (EPS).1 Neuroleptics, the older class of antipsychotic agents, which includes dopamine receptor blocking agents (DRBA), can cause tardive dyskinesia (TD), dystonia, akathisia, and Parkinsonism.

We also learned that newer antipsychotic agents, the so-called second-generation antipsychotics, do not cause EPS. However, dose-related EPS has been associated with olanzapine and risperidone use (> 6 mg/day doses), and there have been two reported cases of aripiprazole-induced EPS.2,3

So which symptoms indicate a drug-induced movement disorder (DIMD)? Patients with DIMDs have difficulty with social functioning, motor-task performance, interpersonal communication, and activities of daily living. They also are less likely to adhere to a medication regimen, making disease relapse and rehospitalization more likely.

Market watch

First-time generics:

  • Dronabinol (generic Marinol);
  • Risperidone (generic Risperdal);
  • Trandolapril (generic Mavik).

New Drugs, Indications, Dosage Forms, and Information

  • Bupivacaine transdermal patch (Eladur) received orphan-drug status for treating pain of post-herpetic neuralgia (PHN). Orphan status gives the manufacturer seven years of marketing exclusivity. This is the same indication that lidocaine patches (Lidoderm) originally received in 1999, although not with orphan-drug status.
  • Dutasteride (Avodart) combined with tamsulosin (Flomax) has been Food and Drug Administration (FDA)-approved for treating symptomatic prostatic hypertrophy.
  • Fluticasone propionate 250 mcg/salmeterol 50 mcg inhalation powder (Advair Diskus 250/50) has been FDA-approved for exacerbation reduction in chronic obstructive pulmonary disease patients with a history of exacerbations.
  • Sumatriptan 85 mg/naproxen sodium 500 mg (Treximet) combination tablets have been FDA-approved for treating acute migraines with or without an aura.
  • Denosumab, a fully humanized monoclonal antibody, is in Phase 3 clinical trials for the treatment of post-menopausal osteoporosis. Its effect on rheumatoid arthritis and cancer-related bone loss is also being studied.

It has a new mechanism of action compared to currently available agents that prevent or treat osteoporosis. It targets RANK Ligand and inhibits early stage osteoclast activity.7 Denosumab also recently met primary and secondary bone mineral density (BMD) study endpoints compared to alendronate. The primary BMD endpoint in the hip was approximately 80% greater for denosumab than alendronate. Denosumab is dosed twice yearly.

Finally, diabetes drugs currently are in the lead for prescription drug spending growth, according to the Medco Annual Drug Trend Report.1 During the past 10 years, lipid-lowering therapies drove this trend. In this most recent report, spending on cholesterol-lowering drugs significantly fell due to the availability of lower priced generics, but still account for 10.8% of all prescription costs.

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