Treatment of tardive dyskinesia with clonazepam: A case report - Chhetri - 2024 - Cli

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VMAT 2 inhibitors such as valbenazine and deutetrabenazine have been approved for treatment of TD by the FDA6, 8 and is the first line drug to treat TD. However, it is not available in our setting. Therefore, an alternate treatment, clonazepam was considered which has some evidence in the treatment of TD. The American Academy of Neurology grades clonazepam as grade B level of evidence which means it is probably effective in the treatment of TD.6, 7, 13

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Although cessation of chlorpromazine and risperidone could have contributed to the remission of his TD symptoms, we believe that the fact clonazepam did actually facilitate the recovery. This is because his TD symptoms were deteriorating when he was being observed before clonazepam was started. His TD symptoms started to diminish after he was put on clonazepam and as the dose was gradually increased the response was even better.

The use of Clonazepam in the treatment of TD was studied from the 1970s–1980s and since then several case reports have reported its success.15, 16 Clonazepam is a long-acting benzodiazepine. Benzodiazepines bind to GABA type A receptors allosterically and increase the frequency of chloride channel opening thereby hyperpolarizing the neurons.7, 10 The GABAergic system has been involved in the pathophysiology of TD and reduction of GABA levels in the basal ganglia have been found in association with TD.7, 10 Additionally, Chih Chun et al. described that a significant number of patients did not exhibit improvement in their symptoms with VMAT2 inhibitors, and that dopamine blockage may not be the only reason in genesis of TD.10

Furthermore, in a 12 week, double-blind, randomized, placebo crossover trial of 19 chronically ill patients with TD taking the FGAs, clonazepam treatment reduced dyskinesia scores by 37% compared with placebo.6 Doses up to 4.5 mg/day of clonazepam have been used and reported in some studies.5, 10 However, it has also been reported that benzodiazepines do induce TD5 and reappearance of TD symptoms have been reported with cessation of benzodiazepine treatment.15



(Note: the link works!)

Doesn’t anybody else here have TD?

Yeah but you make so many posts it's hard to keep up lol . I usually just read the Bipolar check in thread.

Sorry bout that. But I found that article very interesting.

For what it's worth -- I love this kind of stuff and find it fascinating. Please don't hesitate to post articles or discussions like this -- I will write a little later after I read through it a bit more thoroughly! Thank you for posting!

I do have mild TD in my tongue and lip twitches. Pretty much my tongue always moves in my mouth. Seroquel causes it. Every time I've been off Seroquel, it stops. It hasn't worsened though I've been on Seroquel mostly on for over 15 years. At least 10 of those years, I was on clonazepam (finally tapered from a 4 mg/day dose). For me, the clonazepam didn't stop the TD. It doesn't help everyone as the article states. The last time I was put back on Seroquel, I had the worst TD in my hands and legs, especially my hands. The psych hospital was giving me clonazepam, but it didn't help. Time did, amazingly, and I know this is not the case for most people. I stuck it out and within 3 weeks the bad TD symtpoms had lessened and by about a month they were gone. I still do have the tongue/mouth twitches, but I'll take that over having to use fidget toys all day, every day. Pretty much I'm used to my tongue moving constantly in my mouth at this point.

The interesting thing to me is why did I get the TD in my hands & legs that time around and not before then? I'd probably been on and off Seroquel and had changed dosages of it over 10 times through the years. When the pdoc recently added an extra 50 mg Seroquel to my nightly dosage, the only thing that happened was I got night sweats for a couple of nights (always happens to me when I go up or down or off Seroquel). No extra TD thankfully!

And the tapering and getting off clonazepam is a BYTCH! So it's a results vary situation with the situation of getting off the benzo being a nightmarish experience.

I do not have TD, but I am predisposed to it - I have had two scary episodes of acute (not tardive) dyskinesia. This scares me a lot and I will read all your posts about TD, Moose.

In a 12-week randomized trialopens in a new tab or window, the benzodiazepine clonazepam led to a 35% decrease in dyskinesia symptoms, though the few patients who continued on clonazepam for a few months developed a tolerance. It was effective again after a 2-week clonazepam-free period.
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The benzodiazepine clonazepam is associated with TD when patients stop taking the medication acutely. Fast withdrawal from benzodiazepines can lead to withdrawal-emergent dyskinesia, a reversible form of TD, likely caused by the dopamine hypersensitivity.

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First-generation antipsychotics, like haloperidol, chlorpromazine, and fluphenazine, are associated with the highest risk of developing tardive dyskinesia (TD). While second-generation antipsychotics have a lower risk, they can still cause TD. The longer a person takes a dopamine-blocking medication, such as an antipsychotic, the higher their risk of developing TD.

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Clonazepam's effect on brain chemistry can also influence mood and emotions over time. Prolonged use may lead to: Emotional blunting, where emotions feel dampened or numb. Increased risk of depression, which may become more intense over time.

I seem to have the opposite of emotional blunting. I keep crying!

Have you heard from your friend?

Finally this afternoon I did! His fever is gone and his joints don’t hurt anymore.