Tardive dyskinesia (TD) is a serious, often irreversible movement disorder caused by long-term use of dopamine receptor antagonists, particularly antipsychotics. Though many patients are prescribed relatively low doses and monotherapy remains common, this large-scale Japanese claims database analysis revealed a clear dose-dependent relationship between antipsychotic use and the risk of developing TD. Patients who received daily doses exceeding 75 mg chlorpromazine equivalent were at significantly greater risk, especially those taking ≥300 mg/d.

Researchers analyzed data from over 58,000 patients across a 10-year period, identifying TD diagnoses in 80 individuals and comparing them with matched controls. Patients in the TD group were more likely to experience dose escalation and were prescribed higher maximum daily doses earlier in their treatment. Despite existing treatment guidelines recommending dose reduction or discontinuation when TD develops, evidence supporting symptom improvement from dose tapering remains limited. Given the occupational and psychosocial impact of TD, especially in working-age populations, the findings underscore the need for cautious dose management, routine monitoring, and further research to optimize care and minimize harm.

Reference: Gouda M, Abe M, Watanabe Y, Kato TA. Analysis of Antipsychotic Dosage in Patients With Tardive Dyskinesia: A Case-Control Study Using the Claims Database of the Corporate Health Insurance Association. J Clin Psychopharmacol. 2024;44(4):378-385. doi: 10.1097/JCP.0000000000001880.