What Are Extrapyramidal Side Effects?

How Antipsychotics Can Affect Your Movement

Woman tapping fingers on chair, (Close-up)
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Extrapyramidal side effects are a group of symptoms that can occur in people taking antipsychotic medications. They are more commonly caused by typical antipsychotics, but can and do occur with any type of antipsychotic. Antidepressants and other medications can sometimes cause extrapyramidal side effects as well.

Extrapyramidal Side Effects Relate to Motor Control

Extrapyramidal function refers to our motor control and coordination, including being able to not make movements we don't want to make.

Extrapyramidal side effects from medications are serious and may include:

  • Akathisia, which is a feeling of restlessness, making it hard to sit down or hold still. Symptoms include tapping your fingers, rocking and crossing and uncrossing your legs.

  • Parkinsonism, which means you have the same symptoms as someone with Parkinson's disease, but your symptoms are caused by medications, not by the disease. These symptoms may include tremor, slower thought processes, slower movements, rigid muscles, difficulty speaking and facial stiffness.

  • Tardive dyskinesia, which is when you have uncontrollable facial movements such as sucking or chewing, lip smacking, sticking your tongue out or blinking your eyes repeatedly.

  • Dystonia, which is when your muscles involuntarily contract and contort. This can lead to painful positions or movements. 

Treatment for Extrapyramidal Side Effects

Treatment of these symptoms depends upon the medication that induced them and which symptoms you have.

Your doctor may try decreasing your dose or switching your medication altogether to one that has been shown to have fewer extrapyramidal side effects.

Benzodiazepines are sometimes prescribed to help counteract extrapyramidal side effects, as are anti-parkinsonism drugs called anticholinergics. Antipsychotics block dopamine, which is what causes the extrapyramidal side effects in the first place.

Anticholinergics increase dopamine so it becomes levelled out in your system.

Typical Antipsychotics

Typical antipsychotics are the first generation of antipsychotics and are more likely to have extrapyramidal side effects. The U.S. Food and Drug Administration (FDA) has approved these typical antipsychotics:

  • Thorazine (chlorpromazine)
  • Inapsine (droperidol)
  • Prolixin (fluphenazine)
  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Trilafon (perphenazine)
  • Orap (pimozide)
  • Compazine (prochlorperazine)
  • Navane (thiothixene)
  • Mellaril (thioridazine)
  • Stelazine (trifluoperazine)

Other Side Effects of Typical Antipsychotics

Beyond extrapyramidal side effects, these are the most common side effects of typical antipsychotics:

  • Drowsiness and feeling sleepy
  • Feeling agitated
  • Dry mouth
  • Blurred vision
  • Menstrual abnormalities
  • Hypotension, which is when your blood pressure suddenly drops
  • Sexual difficulties
  • Feeling like your mind has slowed down
  • Upset stomach
  • Diarrhea or constipation
  • Vomiting
  • Heartburn
  • Difficulty sleeping

These effects may go away in time, but if they don't or you find them bothersome, be sure to contact your doctor.

Atypical Antipsychotics

Atypical antipsychotics are the newer second-generation of antipsychotics. If you are experiencing extrapyramidal side effects on one of the older, atypical antipsychotics, your doctor may switch you to one of these. FDA-approved atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Saphris (asenapine)
  • Clozaril (clozapine)
  • Fanapt (iloperidone)
  • Zyprexa (olanzapine)
  • Invega (paliperidone)
  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Geodon (ziprasidone)

Other Side Effects of Atypical Antipsychotics

Other than extrapyramidal side effects, these are the most common side effects of atypical antipsychotics:

These effects may go away in time, but if they don't or you find them bothersome, be sure to contact your doctor.

Sources:

Matsumoto, J.Y. " I was recently diagnosed with parkinsonism. What causes it, and how can I cope as it progresses? " Mayo Clinic (2014).

Sanders, R. D., & Gillig, P. M. "Extrapyramidal Examinations in Psychiatry."Innovations in Clinical Neuroscience, 9(7-8), 10–16, (2012).

"Schizophrenia: Medications." The New York Times, Times Health Guide: In-Depth Report, (2013).

Seida JC, Schouten JR, Mousavi SS, etc. "First- and Second-Generation Antipsychotics for Children and Young Adults". Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Feb. (Comparative Effectiveness Reviews, No. 39.)

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