Journal of Neural Transmission

, Volume 121, Issue 4, pp 367–369 | Cite as

Tardive dystonic syndrome induced by the calcium-channel blocker amlodipine

  • Dirk Dressler
Neurology and Preclinical Neurological Studies - Short communication


Identification of drug exposure as a cause for dystonia is important since cessation of the causative agent offers a chance for remission. We describe two patients with a cranial, cervical, pharyngo-laryngeal and axial dystonia, akathisia, breathing dysrhythmias together with depression and anxiety. Both patients were started on the calcium channel blocker (CCB) amlodipine 1 month before symptom onset. They symptoms were non-acute and due to CCBs well-known D2 antagonism; hence they were classified as a tardive dystonic syndrome. Parkinsonism and depression have been described especially for the CCB flunarizine and cinnarizine. Tardive dystonia under CCB has rarely been reported. CCB exposure should be investigated in all dystonias with cranial, cervical, pharyngo-laryngeal and axial manifestations, especially when additional akathisia, Parkinsonism and depression are present. When CCB induction is suspected, CCB cessation may offer a chance for spontaneous remission. Whether CCB exposure can deteriorate, idiopathic dystonia is unclear. Therefore, CCB should best be avoided in patients with dystonia.


Tardive dystonia Calcium channel blocker Amlodipine Breathing dysrhythmia Akathisia Depression Anxiety Dopamine blockade 


Conflict of interest

DD received honoraria for consultations from Allergan, Eisai/Solstice, Ipsen, Merz and Syntaxin. He is a shareholder in Allergan. He holds patents in botulinum toxin research.


  1. Bondon-Guitton E, Perez-Lloret S, Bagheri H, Brefel C, Rascol O, Montastruc JL (2011) Drug-induced Parkinsonism: a review of 17 years’ experience in a regional pharmacovigilance center in France. Mov Disord 26:2226–2231PubMedCrossRefGoogle Scholar
  2. De Melo-Souza SE (1984) Flunarizina, Parkinsonismo e Depressão. In: XI Congresso Brasileiro de Neurologia (Resumos), GoiâniaGoogle Scholar
  3. Essali A, Deirawan H, Soares-Weiser K, Adams CE (2011) Calcium channel blockers for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev. CD000206. doi: 10.1002/14651858.CD000206.pub3
  4. Fabiani G, Pastro PC, Froehner C (2004) Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine. Arq Neuropsiquiatr 62:784–788PubMedCrossRefGoogle Scholar
  5. Fleckenstein A (1983) History of calcium antagonists. Circ Res 52:I3–I16PubMedGoogle Scholar
  6. Micheli F, Pardal MF, Gatto M, Torres M, Paradiso G, Parera IC, Giannaula R (1987) Flunarizine- and cinnarizine-induced extrapyramidal reactions. Neurology 37:881–884PubMedCrossRefGoogle Scholar
  7. Negrotti A, Calzetti S (1997) A long-term follow-up study of cinnarizine- and flunarizine-induced Parkinsonism. Mov Disord 12:107–110PubMedCrossRefGoogle Scholar
  8. Pina MA, Ara JR, Remírez A, Castiella J (1998) Verapamil and acute dystonia. J Clin Pharm Ther 23:79–80PubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Movement Disorders Section, Department of NeurologyHannover Medical SchoolHannoverGermany

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