A patient was started on fluphenazine. After few weeks of treatment, he started developing tremors, rigidity, bradykinesia and excessive salivation. First line of management for this patient is
* Fluphenazine - D2 blocker (Anti-psychotic)* This is a case of typical antipsychotic induced parkinsonism.* The only group of drugs effective against "Pharmacological parkinsonism" (Drug induced parkinsonism) are Anti-cholinergic agents* Trihexyphenidyl:# Has high Central: Peripheral anticholinergic actions than atropine# Acts by reducing unbalanced cholinergic activity in striatum of parkinsonism patients# Order of relief of symptoms: Tremors > Rigidity > Hypokinesia# Peripheral actions - responsible for treatment of sialorrhea# Started at low dose and gradually increased
Trihexyphenidyl
Pramipexole
Amantadine
Selegiline
C.N.S