Anti-aCh for pseudoparkinsonism

Anticholinergics for pseudoparkinsonism

When a patient presents with bothersome symptoms of pseudoparkinsonism, the best treatment is to lower the antipsychotic to the lowest tolerated dose. If dose-lowering without increasing psychotic symptoms is not possible, then the addition of an anticholinergic antiparkinsonism drug is warranted. Similar to acute dystonias, anticholinergic drugs are given to try to restore balance in the nigrostriatal tract. Treatment options include biperiden, dexetimide, and trihexyfenidyl.

The response to these agents is usually within the first few days of treatment. Long term treatment of drug induced pseudoparkinsonsim with anticholinergics should be avoided. If a patient continues to require an anticholinergic agent for more than 3 months, the physician should consider switching the patient to an atypical antipsychotic.


Which of the following agents is considered the drug of choice for pseudoparkinsonism?