Here is one list of drugs from DMRF:
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[INLINE] Medication treatments may lessen the symptoms of pain, spasm, and abnormal posturing and function. These treatments have differing mechanisms of action, so benefits and side-effects may be difficult to predict. One drug may work for one patient and not for another. Sometimes the benefit is only short-lived. The treatment of dystonia must be tailored to the individual patient.
There are several possible categories of medications used in the treatment of dystonia:
Anticholinergics
Anticholinergics include such drugs as Artane (trihexyphenidyl), Cogentin (benztropine), or Parsitan (ethopropazine) which block the acetylcholine. In most people the dosage is limited by central side effects such as confusion, drowsiness, hallucination, personality change, and memory difficulties, and peripheral side effects such as dry mouth, blurred vision, urinary retention, and constipation.
Benzodiazepines
Benzodiazepines, such as Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam) block the Gaba-A receptor in the central nervous system. The primary side effect is sedation, but others include depression, personality change, and drug addiction. Rapid discontinuation can result in a withdrawal syndrome. Some dystonia patients may tolerate very high doses without apparent adverse effects.
Baclofen
Baclofen (Lioresal) stimulates the Gaba-B receptor. Intrathecal (spinal infusion) forms of Baclofen are also available.
Dopamine
Some patients with primary dystonia respond to drugs which increases dopamine such as Sinemet (levodopa) or Parlodel (bromocriptine); however, many patients respond to agents which block or deplete dopamine, such as standard anti-psychotics like Clozaril (clozapine), Nitoman (tetrabenazine), or Reserpine.
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Can you explain how you start a person on a new medication?
Generally, a person starts on a medication at a low dose and slowly increases them. It may take weeks to months to undergo an adequate trial of one medication. Drug trials require tremendous patience in deciding whether one medication will work or not.
It is important to stay in contact with your physician because of the risk of the side effects and to report on how the trial is going.
During a drug trial, you may have to wait at a certain dose level or slowly taper off to discontinuation depending on the severity of side effects. Remember there is no "magic level" which you must obtain. Some people will experience benefits at a relatively low dose without side effects while others will require higher dosages. This is the reason physicians slowly increase the medicine because should you have benefits at a level that is acceptable, then that will probably be your level.
Overall, medication benefits between 40-60% of the dystonia patients, but medications have dose limitations because of side effects. Some reasons for medication failure is the lack of benefit and the occurrence of side effects. Other reasons include inadequate trials, not all possible medications tried, too many medications at one time, rapid increase in dose, or abrupt discontinuation.
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What are the effects of these drugs on longevity?
The medications that are used for dystonia do not shorten life expectancy and can be used, as far as we know, indefinitely. The side-effects may force us to reduce them, but the side-effects are reversible.
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What can be done for patients with drug-induced dystonia? Can it be counteracted?
There are several types of dystonia that can be induced by drug. One type is called an acute dystonic reaction and manifests itself as a dystonic state resulting after a one-time exposure to a medication. The medications that are most likely to induce dystonic reactions are the so-called neuroleptic drugs which have as a common mode of action to block the effects of the neurotransmitter dopamine in the brain. These reactions are generally self-limited but can be quite frightening. Acute dystonia induced by anti-psychotic or anti-emetic agents may be relieved by intravenous Benadryl (diphenhydramine), anticholinergics, or benzodiazepines.
Another type of drug-induced dystonia is called tardive dystonia. Tardive dystonia is produced by the long-term ingestion of drugs such as neuroleptics. The more common type of tardive syndrome is tardive dyskinesia wherein the movements are generally quick movements without sustained postures. Tardive dystonia is similar where many of the movements involve sustained posturing. It is generally considered to be a severe form of tardive dyskinesia. Tardive dystonia, induced by anti-psychotics or anti-emetics may be treated by withdrawal or the offending agents or by anticholinergics, benzodiazepines, baclofen, or clozapine; however this condition may be relatively resistant to treatments.
Tardive dyskinesia and tardive dystonia are very difficult to treat. Once initiated, they can be life-long problems although it is possible that they may spontaneously remit. There are a variety of therapeutic programs that have been suggested to be useful for treatment of tardive dystonia and while some are clearly successful in some patients, there is no therapy that is so uniformly successful that it might be considered a standard of care. Patients who are affected by tardive dystonia need to work closely with their doctors to try to find a successful regimen.
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What drugs can cause tardive dystonia?
Drugs belonging to a class called "dopamine receptor blocking agents," also referred to as "neuroleptics," can cause dystonia. The following is a list of such drugs that can cause dystonia (trade name listed in parenthesis): Acetohenazine (TindalŽ), Amoxapine (Asendin), Chlorpromazine (ThorazineŽ), Fluphenazine (PermitilŽ, ProlixinŽ), Haloperidol (HaldolŽ). Loxapine (LoxitaneŽ, DaxolinŽ), Mesoridazine (SerentilŽ), Metaclopramide (ReglanŽ), Molindone (LindoneŽ, MobanŽ), Perphanzine (TrilafromŽ or TriavilŽ), Piperacetazine (QuideŽ), Prochlorperzine (CompazineŽ, CombidŽ), Promazine (SparineŽ), Promethazine (PhenagranŽ), Thiethylperazine (TorecanŽ), Thioridazine (MellarilŽ), Thiothixene (NavaneŽ),Trifluoperazine (StelazineŽ), Triflupromazine (VesprinŽ), and Trimeprazine (TemarilŽ).
terry gong <tlgongtlgong@...
Is prozac on the no-no list. I recently switched from paxil to prozac.
Terry