title: Drug-induced parkinsonism: a review of 17 years' experience in a regional pharmacovigilance center in France.
abstract: Besides antipsychotics, several drugs can induce parkinsonism. We review spontaneous notifications of drug-induced or -worsened parkinsonism to a French regional pharmacovigilance center between 1993 and 2009. During these 17 years, 20,855 adverse drug reactions have been reported, including 155 (0.7%) cases of drug-induced or -worsened parkinsonism. Most of the notifications have involved aged patients (48% between 60 and 79 years) and females (60%). "Seriousness" was found in 43.9% of cases. Worsening of parkinsonism occurred in 28 patients suffering from idiopathic Parkinson's disease. Sixty-nine percent of drug-induced or -worsened parkinsonism cases were observed during the first 3 months after introduction of the "suspect" drug (involving mainly central dopaminergic antagonists). A second peak (20%) was found 12 months after drug introduction (mainly caused by calcium channel blockers). The most frequently reported parkinsonian symptom was rigidity (78.7%). The three cardinal symptoms were found in 37.4% of notifications. Evolution was favorable (after partial or complete withdrawal of suspect drug[s]) in 88.7% of cases. Among the 261 suspect drugs, most involved central dopaminergic antagonists (49%), followed by antidepressants (8%), calcium channel blockers (5%), peripheral dopaminergic antagonists (5%), and H1 antihistamines (5%). Cases with lithium, valproic acid, amiodarone, anticholinesterases, or trimetazidine were also found. Three notifications were the result of pharmacokinetic interactions. We found that drug-induced or -worsened parkinsonism is an often "serious," but reversible, adverse drug reaction. It occurred more frequently between 60 and 79 years. Rigidity was the most frequently reported symptom. Approximately 50% of drug-induced or -worsened parkinsonism cases spontaneously reported were related to drugs other than antipsychotics. Drug-induced or -worsened parkinsonism can also be explained by pharmacokinetic drug interactions.
authors.affiliation: Laboratoire de Pharmacologie Médicale et Clinique, INSERM U 1027 Equipe de PharmacoEpidémiologie, Faculté de Médecine de l'Université de Toulouse, Toulouse and Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de PharmacoEpidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire, Toulouse, France. guitton@cict.fr
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bondon-Guitton
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Lloret
authors.forename: Haleh
authors.initials: H
authors.lastname: Bagheri
authors.forename: Christine
authors.initials: C
authors.lastname: Brefel
authors.forename: Olivier
authors.initials: O
authors.lastname: Rascol
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Montastruc
mesh_terms: D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D005602:France; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010302:Parkinson Disease, Secondary / Q000139:chemically induced*; D060735:Pharmacovigilance; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents