Hospital Ramón y Cajal, Servicio de Neurología, CIBERNED, Ctra de Colmenar Km 9,100, Madrid, 28034, Spain.
Expert Opin Drug Saf. 2013 Jul;12(4):487-96. doi: 10.1517/14740338.2013.787065. Epub 2013 Mar 31.
Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism after idiopathic Parkinson's disease (iPD). Initially reported as a complication of antipsychotics, it was later recognized as a common complication of antidepressants, calcium channel antagonists, gastrointestinal prokinetics, antiepileptic drugs and many other compounds. Despite being a major health problem in certain populations, it seems to be frequently overlooked by the medical community.
This paper approaches the concept of DIP, reviews its epidemiology, clinical features and ancillary tests recommended for a correct diagnosis. The authors discuss the different drugs and its pathogenic mechanisms. The relevance of an early recognition and recommendations for a correct management are commented.
Prescribers need to remain vigilant for DIP, particularly in the elderly, patients taking multiple drugs and those with genetic risk factors involved in iPD. Cessation of the causing agent is the main treatment and there is no evidence of benefit for the use of anticholinergics or levodopa. If the medication cannot be withdrawn, it should be switched to agents with a lower risk of DIP.
药物性帕金森病（DIP）是继特发性帕金森病（iPD）之后第二常见的帕金森病病因。DIP 最初被报道为抗精神病药的一种并发症，后来被认为是抗抑郁药、钙通道拮抗剂、胃肠动力药、抗癫痫药和许多其他化合物的常见并发症。尽管在某些人群中是一个主要的健康问题，但它似乎经常被医学界忽视。
本文探讨了 DIP 的概念，回顾了其流行病学、临床特征和推荐用于正确诊断的辅助检查。作者讨论了不同的药物及其发病机制。还讨论了早期识别的重要性和正确管理的建议。
处方者需要对 DIP 保持警惕，特别是在老年人、服用多种药物的患者和涉及 iPD 的遗传风险因素的患者中。停止使用致病药物是主要的治疗方法，使用抗胆碱能药物或左旋多巴并没有益处的证据。如果不能停用药物，则应将其更换为 DIP 风险较低的药物。
