Posted by yxibow on May 12, 2009, at 21:49:31
In reply to high dose diphenhydramine for tardive syndromes, posted by iforgotmypassword on May 12, 2009, at 15:16:39
> someone detailed a possible treatment for tardive movement syndromes a while back.
>
> this was the 5-day regimen:
> 1) diphenhydramine (Benadryl) 100mg every 4 hours (this seemed to be mentioned as a 4 times a day thing in another post)
> 2) quercetin 500mg daily
> 3) alpha lipoic acid (no dose specified, i have chosen 100mg with each diphenhydramine dose)First of all that's a near toxic amount of diphenhydramine (unless you're a fast metabolizer)
The remaining items probably have little to do with anything.
If you truly have tardive dyskinesia, a anticholinergic almost always will make it worse. The mechanism isn't completely understood but many an antihistamine/anticholinergic has been thrown at TD.
TD resolves itself in more than 1/3 of people, stays about the same in 1/3 and may worsen with the remaining.
People who have schizophrenia may, only due to the disorder have symptoms that mimic what is characteristically presented as TD so probing into what is actually happening is important.
In the old days of Haldol, the dose was pushed higher and higher and for a while it staved things off but there is a ceiling for it and that is scarcely used today.
However if one still needs an AP, they may have to stay on it regardless.
It is possible in those who have taken stronger or particularly "typical" APs to show lessening of TD when on atypicals, specifically Zyprexa and Seroquel, and definite results with Clozaril *(which has its own problems that it is extremely sedating, can cause drooling -- so can other APs to a rarer extent, and required by law to have blood draws because up to 2% of people get low white blood counts and must discontinue).
Two other medications -may- relieve TD with the possible results of having long term pseudoparkinsonism.
Those are tetrabenazine (which has come to the US now, as an orphan drug for Huntington's) and a much harsher Indian plant derivative (primarily used to be used as a heart medication) called reserpine.
However, I think it is important for someone who suspects TD to be given AIMS (and I forget, there's another exam), which are subjective tests to determine movement issues, often (usually 6 months) while taking APs.Also, a diagnosis by a specialist in neurology is better to really determine what is going on, because what may appear like TD may be a completely different and not tardive effect. There are misdiagnoses.
Tardive dystonia is a bit different -- it can benefit from anticholinergics, benzodiazepines, propranolol (possibly), dopamine agonists (can cause psychosis), and low potency APs, Zyprexa, Seroquel, and Clozaril (these are controversial as they may or may not worsen the syndrome).TDy (dystonia) has more palliative treatments but fewer relapses, at least theoretically, that isn't completely known.
-- Jay
poster:yxibow
thread:895387
URL: http://www.dr-bob.org/babble/20090505/msgs/895444.html