Reactions 584 - 20 Jan 1996

SClomipramine

Tardive dyskinesia in an elderly patient: case reportA 73-year-old man developed persistant tardive dyskinesia

after he started treatment with clomipramine for obsessive-compulsive disorder.

The patient had been receiving long-term treatment withdextroamphetamine, lovastatin, ranitidine and sucralfate forother conditions; he had never received a neuroleptic.

Although the man’s previously untreated obsessive-compulsive disorder responded well to clomipramine 175mg/day, the treatment was discontinued after 7.5 monthsbecause of the development of dyskinesias. These werecharacterised by slow writhing movements of the tonguewithin the mouth, mouth opening and mild choreicmovements of the digits. No improvement was seen afterwithdrawal of clomipramine.

Author comment: ‘The use of clomipramine, with itssignificant anticholinergic effects, appears etiologically relatedto the onset of TD [tardive dyskinesia] in this patient.’ Reducedclearance of the drug, due to the patient’s age and theconcurrent use of hepatic enzyme inhibitors (lovastatin,ranitidine), may have resulted in higher plasma concentrationsand increased anticholinergic effects. The potent dopaminergiceffects of dextroamphetamine could also have contributed tothe onset of tardive dyskinesia.Clayton AH. Antidepressant-induced tardive dyskinesia: review and case report.Psychopharmacology Bulletin 31: 259-264, No. 2, 1995 - USA 800412709

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Reactions 20 Jan 1996 No. 5840114-9954/10/0584-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved