Antipsychotic medications are widely used for psychiatric conditions, but they are associated with significant side effects, including drug-induced movement disorders (DIMDs) like drug-induced parkinsonism, acute dystonia, tardive dyskinesia (TD), and neuroleptic malignant syndrome (NMS). These side effects can be debilitating, especially with polypharmacy or higher doses. While anticholinergic medications are sometimes used to treat DIMDs, they carry additional risks, particularly in older adults or those taking multiple medications with anticholinergic properties. These medications can be effective for conditions like drug-induced parkinsonism but are harmful for TD, akathisia, or NMS.

The expert panel stresses the importance of accurate diagnosis and tailored treatment for DIMDs, as these disorders respond differently to treatment. Anticholinergics are helpful for certain DIMDs like drug-induced parkinsonism and acute dystonia but are contraindicated for TD and NMS. Over-prescription of anticholinergics, especially in vulnerable populations, can lead to cognitive dysfunction, delirium, and increased mortality risk. The panel advocates for better education on the use of anticholinergics, proper tapering strategies, and further research on alternative treatments. Clinicians are also encouraged to avoid grouping all DIMDs under “extrapyramidal symptoms,” as each requires a specific treatment approach.

Reference: Vanegas-Arroyave N, Caroff SN, Citrome L, et al. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders. CNS Drugs. 2024;38(4):239-254. doi: 10.1007/s40263-024-01078-z.