Abstract
Neuroleptic-induced extrapyramidal side effects (EPS) were evaluated in 92 patients treated with clozapine for the first time and 59 patients treated with haloperidol followed in a drug monitoring program. Side effects were measured by the Columbia University Rating Scale, the Simpson Dyskinesia Scale and the Hillside Akathisia Scale. The cumulative incidence rate for tremor was found to be 24.4% in the clozapine group and 39.3% in the haloperidol group. This did not amount to a statistically significant group difference. Bradykinesia was observed in 21.8% of the patients treated with clozapine and in 47.7% of the patients of haloperidol (P=0.011). In the clozapine group the akathisia incidence rate was 5.6%, whereas haloperidol patients showed a higher rate of 31.7% (P=0.005). Our results show higher incidence rates of tremor and bradykinesia during clozapine treatment than previous studies. We conclude that clozapine is not entirely free of EPS, but they are usually less severe and of a different quality than side effects induced by typical antipsychotics.
Similar content being viewed by others
References
Ayd FJ (1983) Early-onset neuroleptic-induced extrapyramidal reactions: a second survey, 1961–1981. In: Cole JT, Enna SJ (eds) Neurleptics: neurochemical, behavioural, and clinical perspectives. Raven Press, New York, pp 75–92
Baldessarini RJ, Frankenburg FR (1991) Clozapine — a novel antipsychotic agent. N Engl J Med 324:746–754
Barnes TRE, Braude WM (1985) Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry 42:874–878
Bergen J, Kitchin R, Berry G (1992) Predictors of the course of tardive dyskinesia in patients receiving neuroleptics. Biol Psychiatry 32:580–594
Brown KW, White T (1992) The influence of topography of the cognitive and psychopathological effects of tardive dyskinesia. Am J Psychiatry 149:1385–1389
Casey DE (1989) Clozapine: neuroleptic-induced EPS and tardive dyskinesia. Psychopharmacology 99:547–553
Chengappa KNR, Shelton MD, Baker RW, Schooler NR, Baird J, Delaney J (1994) The prevalence of akathisia in patients receiving stable doses of clozapine. J Clin Psychiatry 55:142–145
Chiu E, Burrows G, Stevenson J (1976) Double-blind comparison of clozapine with chlorpromazine in acute schizophrenic illness. Aust NZ J Psychiatry 10:343–347
Claghorn J, Honigfeld G, Abbuzahab FS, Wang R, Steinbook R, Tuason V, Klerman G (1987) The risks and benefits of clozapine versus chlorpromazine. J Clin Psychopharmacol 7:377–384
Cohen BM, Keck PE, Satlin A, Cole JO (1991) Prevalance and severity of akathisia in patients on clozapine. Biol Psychiatry 29:1215–1219
Conley RR, Schulz SC, Baker RW, Collins JF, Bell JA (1988) Clozapine efficacy in schizophrenic nonresponders. Psychopharmacol Bull 24:269–274
Ereshefsky L, Watanabe MD, Tran-Johnson TK (1989) Clozapine: an atypical antipsychotic agent. Clin Pharmacol 8:691–709
Fitton A, Heel RH (1990) Clozapine — a review of its pharmacological properties, and therapeutic use in schizophrenia. Drugs 40:722–747
Fleischhacker WW, Bergmann KJ, Perovich R, Pestreich LK, Borenstein M, Lieberman JA, Kane JM (1989) The Hillside Akathisia Scale: a new rating instrument for neuroleptic-induced akathisia. Psychopharmacol Bull 25:222–226
Fleischhacker WW, Miller CH, Schett P, Barnas C, Ehrmann H (1991) The Hillside Akathisia Scale: a reliability comparison of the english and the german versions. Psychopharmacology 105:141–144
Haring C, Fleischhacker WW, Schett P, Humpel C, Barnas C, Saria A (1990) Influence of patient-related variables on clozapine plasma levels. Am J Psychiatry 147:1471–1475
Haring C, Neudorfer C, Schwitzer J, Saria A, Hummer M, Hinterhuber H, Fleischhacker WW (1994) EEG alterations in patients treated with clozapine in relation to plasma levels. Psychopharmacology 114:97–100
Kane J, Honigfled G, Singer J, Meltzer H and the Clozaril Collaborative Group (1988) Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry 45:789–796
Kane J, Dauphinais D, Barnes TRE, Adler LA, Rifkin A (1993) Assessing negative symptoms and extrapyramidal side effects in schizophrenia: Workshop report. Psychopharmacol Bull 29:45–49
Keepers GA, Clappison VJ, Casey DE (1983) Initial anticholinergic prophylaxis for neurolpetic-induced extrapyramidal syndromes. Arch Gen Psychiatry 40:1113–1117
Lesser RP, Fahn S, Snider SR (1979) Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy. Neurology 29:1253–1260
Lieberman JA, Kane J, Woerner M, Weinhold P, Basavarju N, Kurucz J, Bergmann K (1984) Prevalence of tardive dyskinesia in elderly samples. Psychopharmacol Bull 20:382–386
Lieberman JA, Kane JM, Johns CA (1989) Clozapine: guidelines for clinical management. J Clin Psychiatry 50:329–338
Lieberman JA, Saltz BL, Johns CA, Pollack S, Borenstein M, Kane J (1991) The effects of clozapine on tardive dyskinesia. Br J Psychiatry 158:103–110
Lindström LH (1988) The effect of long-term treatment with clozapine in schizophrenia: a retrospective study in 96 patients treated with clozapine for up to 13 years. Acta Psychiatr Scand 77:524–529
Naber D, Leppig M, Grohmann R, Hippius H (1989) Efficacy and adverse effects of clozapine in the treatment of schizophrenia and tardive dyskinesia — a retrospective study of 387 patients. Psychopharmacology 99:73–76
Panteleeva GP, Tsutsul'kovskaya MY, Belyaev BS, Minsker EI (1987) Clozapine in the treatment of schizophrenic patients: an international multicenter trail. Clin Ther 10:57–68
Povlsen UJ, Noring U, Fog R, Gerlach J (1985) Tolerability and therapeutic effect of clozapine. A retrospective investigation of 216 patients treated with clozapine up to 12 years. Acta Psychiatr scand 71:176–185
Rifkin A, Siris S (1987) Drug treatment of acute schizophrenia. In: Meltzer HY (ed) Psychopharmacology: the third generation of progress. Raven Press, New York, pp 1095–1101
Safferman A, Lieberman JA, Kane JM, Szymanski S, Kinon B (1991) Update on the clinical efficacy and side effects of clozapine. Schizophr Bull 17:247–261
Safferman A, Lieberman JA, Pollack S, Kane JM (1993) Akathisia and clozapine treatment. J Clin Psychopharmacol 13:286–287
Schmauss M, Wolff R, Erfurth A, Rüther E (1989) Tolerability of long term clozapine treatment. Psychopharmacology 9:105–108
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kurz, M., Hummer, M., Oberbauer, H. et al. Extrapyramidal side effects of clozapine and haloperidol. Psychopharmacology 118, 52–56 (1995). https://doi.org/10.1007/BF02245249
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02245249