6 Medications That May Cause Tardive Dyskinesia

Tardive dyskinesia (TD) is a movement disorder that can result from taking certain medications. It’s characterized by involuntary and repetitive movements of the face, limbs, and trunk. For some people, adjusting the medication dose or switching treatments can help lessen or resolve symptoms. But for others, TD may be permanent.

Several classes of medications have been linked to a greater risk of developing TD. Most of the time, it’s because they block dopamine receptors (binding sites) in the brain. Antipsychotic medications are well-known culprits.

But certain antidepressants, anti-seizure medications, and nausea treatments may cause it, too. If TD develops, identifying and managing it early can help prevent your symptoms from getting worse.

Below, we cover six medications that may cause tardive dyskinesia.

1. Antipsychotic medications

Antipsychotics treat a range of mental health conditions. They’re generally categorized into two groups: typical and atypical antipsychotics.

Typical (or first-generation) antipsychotics came out first, and include haloperidol (Haldol) and prochlorperazine. Atypical antipsychotics came out later, and include risperidone (Risperdal) and quetiapine (Seroquel).

Researchers think about 20% of people who take antipsychotic medications develop TD, on average. But it usually appears after years of use. Short-term use doesn’t usually cause TD.

First-generation antipsychotics have the highest TD risk. This is because they attach more tightly to dopamine receptors compared to atypical antipsychotics. While the risk from atypical antipsychotics seems lower, TD can still be a concern.

2. Anti-nausea medications

There are many over-the-counter and prescription medications used to treat nausea. Some anti-nausea medications work by blocking dopamine receptors in your brain. But this can also cause TD as a side effect. These include prochlorperazine and metoclopramide (Reglan).

As mentioned above, prochlorperazine is a typical antipsychotic. But it’s also used as an anti-nausea medication. The risk of TD from prochlorperazine goes up the longer you take it, and with higher doses. But it’s still possible to get TD after a short amount of time at low doses.

Metoclopramide is another anti-nausea medication that could cause TD. In fact, it has a boxed warning (the FDA’s strictest warning) about the risk of TD. To lower this risk, it’s typically recommended to avoid taking metoclopramide for longer than 12 weeks.

3. Antidepressants

Antidepressants treat depression and other conditions like anxiety disorders and nerve pain. TD has been reported in people taking certain antidepressants. This risk may be higher in older adults who’ve been taking antidepressants long term.

It isn’t clear why some antidepressants may cause TD. Researchers think it might have to do with the higher serotonin levels in the brain caused by some antidepressants. This could affect dopamine levels in certain parts of the brain. Other antidepressants, like amoxapine, have dopamine receptor-blocking effects.

Some examples of antidepressants linked to TD as a side effect include:

• Amoxapine

• Trazodone

• Doxepin

• Clomipramine (Anafranil)

• Venlafaxine

• Amitriptyline

• Fluoxetine (Prozac)

4. Lithium

Lithium (Lithobid) is a medication prescribed to treat bipolar disorder. There are reports of people developing TD while taking lithium on its own. Experts don’t know for sure why this may happen. But the risk of TD is higher if you’re taking it in combination with antipsychotic medications.

It’s estimated that about 23% of people with bipolar disorder taking this combination develop TD. If you’re taking lithium with an antipsychotic, discuss your TD risk with your healthcare provider.

5. Seizure medications

While rare, some antiseizure medications are associated with movement disorders, including TD. Examples include lamotrigine (Lamictal) and phenytoin (Dilantin). Uncontrollable muscle movements are listed as an infrequent or rare side effect for all of these medications.

TD associated with phenytoin seems to happen more often in children and young adults. High levels and doses of phenytoin might be a risk factor for TD, as well as taking it for a long time.

6. Malaria medications

Antimalarials are a class of medications used to prevent and treat malaria. Chloroquine is a common option for most people. But it has also been linked to TD and other movement problems. It’s not fully understood why some people develop movement problems from chloroquine.

If you’re traveling to an area with malaria, you may be prescribed chloroquine to take before, during, and after your trip. TD from chloroquine seems to be rare. But it may be something to watch out for while you’re taking it.

Ways to lower your risk of tardive dyskinesia from medications

Not everyone who takes these medications will develop TD. But longer-term use and higher doses are associated with a higher risk. Older adults, women, and people with diabetes may also have a higher risk of TD.

It isn’t always possible to avoid the medications listed above. And stopping them cold turkey on your own isn’t recommended, either.

But here are some steps your healthcare provider may recommend to lower your risk of TD while taking them:

• Find the lowest dose that works for you. Your healthcare provider can help you figure out the lowest dose that treats your condition.

• Choose a medication with a lower TD risk. For example, your healthcare provider may prescribe a second-generation antipsychotic over a first-generation antipsychotic, especially if you have a higher risk of developing TD.

• Take the medication for the shortest amount of time possible. Keep up with your follow-up appointments. Your healthcare provider can reassess if you still need to continue your medications. Don’t attempt to stop taking them on your own.

• Avoid alcohol. A history of alcohol use is associated with a higher risk of developing TD in people who take antipsychotic medications. Your healthcare provider may recommend avoiding or limiting alcohol during treatment.

If you’re taking a medication associated with TD, watch out for early signs and symptoms. These include fast eye blinking, repetitive chewing, and sticking out the tongue. Let your healthcare provider know right away if you see any abnormal body movements.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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