Tardive dyskinesia: managing multiple medications

Tardive dyskinesia (TD) is a condition that causes repetitive, involuntary movements. It most often occurs as a side effect from neuroleptic (also known as antipsychotic) medications used to treat schizophrenia and bipolar disorder. It can be caused by certain medications for other medical conditions as well, including Parkinson’s disease, nausea, allergies, malaria, and seizures.

The repetitive, involuntary movements that occur as a result of TD can affect the face, tongue, limbs, trunk, and neck. These symptoms can cause significant social distress and physical discomfort, and TD affects all areas of a person’s life.

Treatment for tardive dyskinesia

While there is no cure for TD, there are medications and strategies that can help reduce symptoms.

VMAT2 inhibitors

Medications called vesicular monoamine transporter 2 (VMAT2) inhibitors can help reduce involuntary movements. These medications work by lowering neurotransmitter activity. Several are approved and available through prescription and are worth discussing with a healthcare provider.

Adjustments to TD-causing medication

The conditions associated with TD require ongoing treatment with neuroleptics or other medications. This means a person will typically need to continue taking a medication that caused or contributed to TD.

A healthcare provider may adjust the dosage or switch to a different medication. This can help slow the progression of TD—but it cannot be emphasized enough that this should only be done under the careful guidance of a healthcare provider. For people taking neuroleptics, stopping treatment can lead to relapsing psychosis and worsening symptoms of mental illness.

Also, involuntary movements can worsen when medication is stopped. This applies to neuroleptics as well as other types of medications associated with TD.

Managing multiple medications

For the reasons described above, people living with TD often need to take multiple medications—neuroleptics or other medications for an underlying condition, medications for TD, and potentially medications for other health needs.

Adhering to a medication schedule that involves multiple drugs for multiple conditions can be challenging. Following a medication schedule as exactly as possible is critical to getting the most benefit from treatment.

If you are taking multiple medications, the strategies below may be helpful.

Learn about your medications

• Have clear instructions from your healthcare provider for each medication. Instructions should include what time of day each medication needs to be taken, if the medication needs to be taken with food, and any other instructions.
• Learn about the medications you are taking, including how they work and why it is important to take each as prescribed.
• Know what to do if you miss a dose of a medication.
• If you have any questions or concerns about a medication, ask your healthcare provider. Your pharmacist is also a great source of information.

Stay organized

• Use a pill organizer, a container that places pills into individual doses labeled with the days of the week. Some pill organizers also include multiple compartments for each day, which is helpful if you need to take medications at different times each day. Set a reminder to refill the pill box at the same time each week.
• Write down a detailed daily and weekly medication schedule. Include any special instructions. This schedule can also be helpful to anyone sharing caregiving responsibilities.
• Store all of your medications in the same place and keep that space well organized.

Reminders and routines

• Set alarms and reminders on your phone. There are also a number of apps for medication reminders.
• Have a backup reminder. For example, if you are using an alarm, also leave a note or some other visual reminder in a place where it will be difficult to miss.
• Make taking medications part of a daily routine, such as brushing your teeth.

Plan ahead

• Plan for unplanned interruptions. Have doses of a medication with you if you will be out of the house and may not be home in time to take a medication.
• Plan ahead if you know you are going to be traveling. Pack enough doses of each medication, have extra doses, have a copy of your schedule, medical information, and emergency contacts.

Last but not least, if you or a loved one is having difficulty taking medications for any reason, talk to your healthcare provider, and ask for help.