Diltiazem, nifedipine, nimodipine or verapamil for neuroleptic-induced tardive dyskinesia

Abstract

Background: Tardive dyskinesia (TD) is a potentially disfiguring movement disorder of the orofacial region often caused by use of neuroleptic drugs. A wide range of strategies have been used to help manage TD and, for those who are unable to have their antipsychotic medication stopped or substantially changed, the calcium-channel blocking group of drugs (diltiazem, nifedipine, nimodipine, verapamil) has been suggested as a useful adjunctive treatment.

Objectives: To determine the clinical efficacy of calcium-channel blockers in people with neuroleptic-induced tardive dyskinesia (TD) and schizophrenia or other chronic mental illnesses.

Search strategy: Electronic searches of Biological Abstracts (1982-1995), Cochrane Schizophrenia Group's Register of trials (1995), EMBASE (1980-1995), LILACS (1982-1996), MEDLINE (1966-1995), PsycLIT (1974-1995), and SCISEARCH were undertaken. References of all identified studies were searched for further trial citations. Principal authors of trials were contacted.

Selection criteria: The inclusion criteria for all relevant randomised studies were that they should focus on people with schizophrenia or other chronic mental illnesses, with neuroleptic-induced TD and compare the use of calcium-channel blockers to placebo or no intervention.

Data collection and analysis: No data could be extracted from the two randomised controlled trials that are currently awaiting assessment. The authors have been contacted to provide the relevant information.

Main results: No studies met the entry criteria. No data were synthesized.

Reviewer's conclusions: Based on currently available information, no confident statement can be made about the effectiveness of calcium-channel blockers for treating people with neuroleptic-induced tardive dyskinesia. Before evaluation of these drugs in larger randomised controlled trials, clinicians should carefully weigh up their possible benefits against their potential adverse effects.