title: Clozapine and tardive movement disorders: a review.
abstract: BACKGROUND
  Tardive syndromes (TS) arise from long term exposure to dopamine receptor blocking agents. Clozapine has been considered to have low risk of causing new onset TS and is considered as a treatment option in patients with TS.
  
  
  OBJECTIVE
  This review evaluates the usefulness of clozapine in patients with TS and occasional reports of clozapine causing TS.
  
  
  METHODS
  Electronic searches were carried out using the search engines of PUBMED, Science direct and Google Scholar databases. All reports describing use of clozapine in management of TS, monitoring of TS while on clozapine and onset of TS after initiation of clozapine were identified.
  
  
  RESULTS
  Fifteen trials and 28 case series/case reports describe the use of clozapine in TS. Most of these reports show that clozapine is useful in patients with TS, in the dose range of 200-300 mg/day and the beneficial effect is seen within 4-12 weeks of initiation. One case series and two case reports described clozapine withdrawal emergent dyskinesias suggesting a masking role of clozapine. One trial, three case series and two case reports describe beneficial effects of clozapine on long standing neurological syndromes. There is relatively less literature (2 trials and 15 case series/reports) describing the emergence of TS with clozapine.
  
  
  CONCLUSIONS
  Evidence of beneficial effects of clozapine in TS is greater than its role in causation/worsening of TS. Hence, clozapine should be considered in symptomatic patients who develop TS while receiving other antipsychotics. Further research on mechanism of TS and clozapine effect on TS is required.
authors: Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
authors: Nandita
authors: N
authors: Hazari
authors: Natasha
authors: N
authors: Kate
authors: Sandeep
authors: S
authors: Grover
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003024:Clozapine / Q000009:adverse effects* / Q000627:therapeutic use; D004409:Dyskinesia, Drug-Induced / Q000209:etiology*; D006801:Humans; D011618:Psychotic Disorders / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine
keywords: Clozapine; Tardive dyskinesia; Tardive dystonia; Tardive syndromes