Tardive Blepharospasm Associated With Cinnarizine Use

Cinnarizine- and flunarizine-associated movement disorder: a literature review

Introduction

Cinnarizine (CNZ) and flunarizine (FNZ) belong to the calcium channel blockers class of medication.

Main text

The aim of this literature review is to evaluate the clinical epidemiological profile, pathological mechanisms, and management of CNZ/FNZ-associated movement disorder (MD). Relevant reports in six databases were identified and assessed by two reviewers without language restriction. One hundred and seventeen reports containing 1920 individuals who developed a CNZ/FNZ-associated MD were identified. The MD encountered were 1251 parkinsonism, 23 dyskinesias, 11 akathisia, 16 dystonia, and 5 myoclonus, and in the group not clearly defined, 592 extrapyramidal symptoms, 19 tremors, 2 bradykinesia, and 1 myokymia. The predominant sex was female with a percentage of 72.69% (466/641). The mean age was 74.49 (SD, 7.88) years. The mean CNZ dose was 148.19 mg (SD, 42.51) and for the FNZ dose, 11.22 mg (5.39). The mean MD onset and recovery were 1.83 years (SD, 1.35) and 3.71 months (SD, 1.26). In the subgroup of subjects that had improvement of the symptoms, the complete recovery was achieved within 6 months of the drug withdrawal in almost all subjects (99%). The most common management was drug withdrawal. A complete recovery was observed in 93.77% of the patients (437/466).

Conclusions

CNZ/FNZ-associated MD was extensively reported in the literature. Parkinsonism was the most well described. Myoclonus (MCL) was the poorest described MD with missing data about the neurological examination and electrodiagnostic studies. The knowledge of this disorder probably can contribute to the understanding of the other drug-induced MDs.

Tardive dystonia improved with discontinuation of trazodone in an elderly schizophrenia patient: a case report

BACKGROUND

Tardive dystonia associated with antidepressant use is rare and often under-recognized. We had an experience with trazodone, which is used for delirium and insomnia prescribed in general hospital, inducing tardive dystonia.

CASE PRESENTATION

A 61-year-old Japanese woman had been treated for schizophrenia. She was moved to general hospital because of consciousness disturbance. She was prescribed trazodone (25 mg/day) for delirium and insomnia. After she was discharged, she returned to the psychiatric hospital with tardive dystonia. Her dystonia symptoms improved with 3 days of discontinuing trazodone.

CONCLUSION

In the present case, long-term use of trazodone induced tardive dystonia. Discontinuing trazodone rapidly improved tardive dystonia.