Neuroleptically induced dystonia in Huntington's disease: a case report

A patient with Huntington's disease developed acute dystonia whilst treated with tiapride. Sulpiride and tetrabenazine also induced dystonia. The anticholinergic biperiden depressed the syndrome but worsened psychopathology. Finally a combination of tetrabenazine and clozapine was successful in treatment of both chorea and dystonia. According to this observation, acute dystonia may occur in Huntington's disease as a consequence of neuroleptic treatment.

Withdrawal syndrome following subchronic treatment with anxiolytic agents

The acute administration of diazepam (0.1-2.5 mg/kg IP), sulpiride (0.5-20 mg/kg IP) and tiapride (0.5-40 mg/kg IP) to the mouse enhanced exploratory activity (rearings/line crossings) in the brightly illuminated white area of a two compartment white/black anxiety test box, with a corresponding decrease in the black, indicating an anxiolytic action. This profile of change was maintained during a twice daily administration for 7 days with diazepam (2.5 and 10 mg/kg), sulpiride (5 and 20 mg/kg) and tiapride (10 and 40 mg/kg). However, 8 and 48 hr following withdrawal of diazepam, the profile of exploratory behaviour was reversed to a preference for the black area: by 96 hr values for behaviour had returned to control levels. In contrast, an anxiolytic profile of action was maintained 8 and 48 hr following the withdrawal of sulpiride and tiapride, the values returning to control levels after 96 hr. It is concluded that a sub-chronic treatment with diazepam, sulpiride and tiapride induces an anxiolytic profile of action in the mouse model, that an anxiogenic profile follows the abrupt withdrawal of diazepam but that this is not recorded following the abrupt withdrawal of sulpiride and tiapride.

Effects of tiapride in tardive dyskinesia

Tiapride, a selective D2 dopaminergic receptor blocking agent from the substituted benzamide class, was evaluated in a blind video-controlled trial in 10 psychiatric patients with tardive dyskinesia. There was a significant decrease in dyskinesia with a parallel increase in parkinsonism. This relationship between two opposite effects on movement suggests a common pathophysiological basis lying on a reciprocal hyper- and hypoactivity of the dopaminergic striatal system. Nevertheless, other mechanisms may be involved, for the evolution of individual parkinsonian and dyskinesia scores is not necessarily opposite: the tiapride-induced parkinsonism was generally acceptable and in two cases, the dyskinesia scores were reduced without an increase in parkinsonism. Therefore, more dyskinetic patients have to be evaluated in long-term studies with tiapride, before this drug could be recommended in tardive dyskinesia, when dyskinetic movements become intolerable.

Recurrent neuroleptic malignant syndrome due to tiapride and haloperidol: the possible role of D-2 dopamine receptors

Two typical recurrent episodes of neuroleptic malignant syndrome (NMS) in the same patient are described. The first episode was caused by a sulpiride derivative, tiapride. This is the first case in which a drug of the benzamide group has been reported to have caused such adverse drug reaction. In the second episode, NMS occurred due to haloperidol in the lowest dose ever reported and was accompanied by highly excessive levels of various muscle enzymes. Involvement of hypothalamic and striatal dopamine system, and particularly of D-2 subtype receptors, is suggested by this case.

[Controlled study of the analgesic efficacy of 2 drugs: tiapride versus aspirin]

Analgesic effect of aspirin 500 mg IM or IV and tiapride 300 mg IM or IV was compared in a double blind controlled study. Twenty-four patients with active cancer were each given both drugs successively, over 48 hours. No difference was demonstrated in analgesic effects of tiapride (14/24: 58%) and aspirin (11/24: 46%), or in toxicity which was minor for both drugs.

Tiapride versus placebo: a double-blind comparative study in the management of Huntington's chorea

A double-blind, placebo-controlled, crossover trial was carried out in 29 patients with Huntington's chorea to evaluate the effectiveness and tolerance of high doses of tiapride in the management of neurological symptoms. Patients were allocated at random into 3 groups to receive 3 g tiapride daily for two periods of 3 weeks either preceded, interrupted or followed by a 3-week period on placebo. Patients were assessed on entry and at the end of each treatment period using a battery of tests designed to measure choreatic movements, motor skills, recognition and reaction times, and mental state. Twenty-three patients completed the trial; only 2 of the 6 drop-outs withdrew because of drug-related side-effects (sedation and extrapyramidal signs). The results showed that tiapride treatment significantly improved choreatic movements and motor skills and these findings were supported by the objective psychometric measurements. Overall evaluation of effectiveness by the physician and patients indicated the significant superiority of tiapride over placebo. Treatment was generally well tolerated and although there were significantly more reports of sedation and extrapyramidal signs whilst patients were receiving tiapride, these effects were rated as mild in most cases and did not interfere with treatment.

[Use of tiapride in the anxious alcoholic]

The alcoholic patient is usually anxious. Anxiety is increased by withdrawal. The anxiety-relieving effect of tiapride was studied in 20 alcoholics, with a mean age of 44 years. 18 patients were male. Alcoholism was chronic in 18 cases and paroxystic in two. At the time of withdrawal each patient was given 3 intramuscular injections daily for 7 days, then 3 tablets per day. Results, which were evaluated according to the Hamilton score, were excellent in 9 cases, good in 10 and poor in 1: no failure was recorded. The symptoms which responded best were fear, somatic and psychic manifestations of anxiety, depressive feelings and sleep disturbances. Concomitantly, digestive disorders, anorexia, tremor and pain were alleviated. Tolerance was excellent: no neurologic, digestive, cardiovascular or biologic manifestations were recorded. In caring for alcoholic patients, the critical time of withdrawal is undeniably facilitated by the use of tiapride.

Application of a primate model for tardive dyskinesia

Persistent signs of oral dyskinesia (tongue protrusion and facial grimacing) had developed as a result of earlier chronic treatment with neuroleptics in a Cebus apella monkey. When this animal was given single doses of any classical neuroleptic, a transient deterioration of dyskinesia occurred, preceded by a temporary abolishment of dyskinesia sometimes with an attack of acute dystonia. Fluphenazine (5-25 micrograms/kg) causes dose-related deteriorations of dyskinesia. Six different drugs were tested on this monkey for their capacity to elicit aggravation of dyskinetic signs: three antihistamines (brompheniramine, promethazine, diphenhydramine) and three dopamine D2 receptor antagonists (sulpiride, tiapride, metoclopramide). High doses of promethazine and diphenhydramine (5 mg/kg) induced a temporary alleviation of dyskinesia, possibly through sedation. All three D2 receptor antagonists precipitated signs of acute dystonia at some dose levels, but out of the test drugs only metoclopramide caused deterioration of dyskinetic symptoms. According to the present results only metoclopramide stands out as a drug with an inherent propensity to cause tardive dyskinesia.

[Tiapride in psychosomatic medicine]

In psychosomatic medicine the indication of tiapridal may appear incomplete if it is based only on symptoms. This study takes into account certain psychopathological tendancies of the patient which are always present in a more or less attenuated form. Numerous psychosomatic manifestations are thus found to be episodic expressions of minor depression or moderate psychoneurotic disorders. Tiapridal is remarkably effective in resolving these symptoms.

Tiapride versus glafenine: a double-blind comparative study in the management of acute rheumatic pain

A double-blind study was carried out in 42 patients suffering from acute rheumatic pain to compare the analgesic effectiveness and tolerance of tiapride with that of glafenine, a widely used analgesic in Europe. Patients were allocated at random to receive either 100 mg tiapride or 200 mg glafenine 3-times daily over a period of 14 days. Pain intensity was rated daily by the patients using a visual analogue scale and an overall assessment of response to treatment was made by both patients and physician at the end of the study. The results showed that, whilst both treatments resulted in a marked reduction in mean pain scores, pain disappeared completely in 16 (76%) of the 21 patients treated with tiapride compared with 9 (43%) of the 21 receiving glafenine. There was also a significant difference in favour of tiapride in the physician's overall assessment of response which was considered as excellent in 71% of the patients on tiapride compared with 31% receiving glafenine. Both treatments were well tolerated and few side-effects were reported. Drowsiness occurred in 6 patients on tiapride but this was only mild in 5 and moderate in the other patient.

[Treatment of alcoholic patients with tiapride]

The neuropsychiatric manifestations of alcoholism can be amended by neutralizing the somatic effects of alcohol on nervous centers. Tiapride acts electively on the mesolimbic area. Promising results have been obtained with tiapride in the various clinical forms of alcohol intoxication. Sixty patients (40 men and 20 women) were given tiapride for abnormal symptoms due to alcohol. Tolerance was good: no side-effects were recorded, with the exception of extrapyramidal manifestations in one patient. Symptoms due to alcohol abuse were alleviated. Relief of tremor was significant. Tiapride proved helpful in anxiety and depression and caused hallucinations to disappear in 35 cases.

[Clinical experience with tiapride in the treatment of extrapyramidal syndromes]

Tiapride was given at an average dosage of 300-900 mg per day, intramuscularly for the first three days, then by oral route, to 62 patients with abnormal movements of various types. The best responses were recorded in chorea and bucco-lingua-facial dyskinesia as well as in dyskinetic movements induced by levo-dopa in Parkinson patients. Clinical and biological tolerance of tiapride was excellent, with only one case of drowsiness and two cases of galactorrhea.

[Post-traumatic headache in outpatient therapy]

The author reports results achieved by a benzamide, tiapride, in the treatment of 43 subjects showing post-traumatic headaches in a INAIL out patient department of neurology. The drug was administered per os at a dose of one tablet twice a day at the beginning of the treatment. In 9 cases, the posology was afterwards increased to 3 tablets. Results were good in 72,1% of the cases and the positive action of the drug was not limited to the disappearance of the headache, but was extended to the total symptomatology of the subjective syndrome of the patients suffering from cranium trauma. The drug was well tolerated in all the cases except in one: the treatment had to be interrupted on account of vertigo sensations. The author confirms the possible activity of the molecule in posttraumatic headaches. He also points out the facility that it offers for the social and working recovery of the subject.

[Clinical trial of tiapride in patients with dyskinesia (author's transl)]

Twenty-five patients with various forms of dyskinesia were given tiapride for three months. Maximal dosage was 900 mg per day. A double-blind trial of tiapride versus placebo showed significantly better results in the group given tiapride. The forms of dyskinesia which responded best to tiapride were the following: iatrogenic dyskinesia, tics (Gilles de la Tourette syndrome), and chronic chorea (Huntington disease). Patients with complex dyskinesia resulting from neonatal encephalopathy or vascular disease were not improved. The protocol used in l-dopa-induced dyskinesia is described. Changes in dyskinesia and "on-off" effect following variations in tiapride and l-dopa dosage are detailed. An unequivocal, although minor, tiapride-induced parkinson syndrome was recorded in a few patients. No instances of tiapride-induced dyskinesia or akathisia were seen. The other side-effects were either psychic (depression, drowsiness, agitation) or endocrinologic (menstrual disorders, overeating, galactorrhea).

[A clinical study of tiapride in ten patients with chronic respiratory failure and in ten patients before fiberoptic bronchoscopy (author's transl)]

Ten patients with chronic respiratory failure (PaO2 = 56,19 +/- 10,54; PaCO2 = 49,17 +/- 7,31 torr) were given intramuscular injections of tiapride, Changes in alveolar ventilation were assessed clinically and by monitoring blood gases. No adverse effects were recorded. PaO2 was similar before and one hour after tiapride. There was no hypoventilation but, on the contrary, a slight decrease in PaCO2 (49,17 +/- 7,3 and 47,10 +/- 7,3 torr) and a significant increase in pH (7,358 +/- 0,023 and 7,378 +/- 0,028; p less than 0,05). Tiapride was also given to ten patients before fiberoptic bronchoscopy. Endoscopy was well tolerated in eight patients, in six there was no anxiety, and in all normal vigilance was retained.

Treatment of acute alcohol withdrawal syndrome with carbamazepine: a double-blind comparison with tiapride

A double-blind, randomized trial is described which was designed to compare the clinical effect of 600 mg daily of carbamazepine (Tegretol) and of tiapride (Sereprile) in hospitalized patients with pre-delirium tremens. Physicians' assessment of patients' progress was made following 2, 4 and 7 days of treatment. Of the sixty patients admitted to the study, five dropped out for various reasons, leaving fifty-five patients who completed the study. Both drugs were effective in the treatment of alcohol withdrawal symptoms; no significant difference was found between the two treatments with respect to total symptoms, score and visual analogue scale assessment. Carbamazepine gave faster relief of symptoms and demonstrated a preferential action on symptoms like fear and hallucinations. No case of delirium tremens was observed in those patients who completed the trial.

Acute dyskinesias in monkeys elicited by halopemide, mezilamine and the "antidyskinetic" drugs, oxiperomide and tiapride

Oxiperomide and tiapride are dopamine receptor antagonists claimed to have "antidyskinetic" properties in animal models and the clinic. Halopemide and mezilamine are other dopamine antagonists predicted to lack extrapyramidal side effects in man on the basis of animal studies. Acute dyskinesias, a neuroleptic-induced acute extrapyramidal syndrome, were elicited in squirrel monkeys by oxiperomide (1 mg/kg), tiapride (30 mg/kg), and halopemide (10 mg/kg). The dyskinesias were virtually indistinguishable from those caused by a standard behaviorally equivalent dose of haloperidol (1.25 mg/kg PO) in the same individual monkeys. Mezilamine (0.3 mg/kg) also induced dyskinesias, which appeared to be less pronounced than those following haloperidol. The antidyskinetic properties of oxiperomide and tiapride evidently do not confer protection against dyskinetic movements induced by dopamine antagonism.

[Migraine and tiapride. A controlled study (author's transl)]

Patients complaining of migraine often consult the hepato-gastro-enterologist because of dyspepsia or "crise de foie". The treatment of the migraine must improve those symptoms which lead to a wrong diagnosis and to inadequate treatments. Several medication are available to treat the migraine. The tiapride, already known as being effective in common or secondary headaches, was given to 40 patients complaining of migraine. The controlled study done versus placebo clearly proves that this medication is effective. It should be used in the treatment of migraine.

[Tiapride and painful attacks of drepanocytosis (author's transl)]

Patients with drepanocytosis require frequent hospitalization for treatment of the severe attacks of pain induced by the disease process. Therapy is often of limited extent and vasodilators, the usual medication employed, do not give very satisfactory results. A study with tiapride demonstrated that this compound could be effective both for curative and preventive treatment, probably in relation to its direct action on pain centres. Very good results were obtained in 11 cases, good results in 8, moderate results in 2, and no result in one case only.