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Tardive dyskinesia and cocaine

From: MKomrad@aol.com
Date: Sat, 7 Sep 1996 17:30:09 -0400
Subject: Tardive dyskinesia and cocaine

A patient on fluoxetine 60 daily, trifluoperazine 2-6 daily, and alprazolam 2 daily was discovered to have been regularly abusing cocaine and developed a possible movement disorder (right foot tapping, involuntary, increasing when relaxed or focused elsewhere). Any relationship between cocaine (or other stimulants) and TD or other movement disorders?

--Richard David Brand, M.D.

Cocaine can most definitely potentiate TD. It is a dopaminergic agonist and also causes dopamine reuptake inhibition. Hence, it can definitely lead to increased binding at upregulated domaminergic receptors in the basal ganglia caused by neuroleptics and either bring out or exacerbate TD.

Theoretically, cocaine would actually decrease acute extrapyramidal symptoms such as neuroleptic-induced parkinsonism and dystonic reactions. I once saw a patient who said he used cocaine to self-medicate those problems on neuroleptics. He hadn't been working closely enough with his psychiatrist to try to treat those extrapyramidal side effects with conventional prescription remedies (e.g., benztropine).

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[dr. bob] Dr. Bob is Robert Hsiung, MD, dr-bob@uchicago.edu

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