Question

A patient was recently started on Fluphenazine. A few weeks later, he developed tremors, rigidity, bradykinesia, and excessive salivation. The first line of management for this patient is

• A. Selegiline
• B. Trihexyphenidyl
• C. Pramipexole
• D. Amantadine

Answer 1

The Correct Option is B

The symptoms described in the scenario—tremors, rigidity, bradykinesia, and excessive salivation—are characteristic of drug-induced parkinsonism. This condition is a common side effect of antipsychotic medications like Fluphenazine, which is a typical antipsychotic known to cause extrapyramidal side effects due to dopamine receptor blockade.
In treating drug-induced parkinsonism, the first line of management is to use anticholinergic agents as they help restore the balance between acetylcholine and dopamine in the central nervous system.
Trihexyphenidyl is an anticholinergic medication effective in alleviating the symptoms of parkinsonism. It reduces tremors and muscle stiffness, improving movement disorders.
Let's consider the options provided:

• Selegiline: A MAO-B inhibitor used primarily in Parkinson's disease, not typically for drug-induced symptoms.
• Trihexyphenidyl: Correct choice, as it's an anticholinergic effective for drug-induced parkinsonism.
• Pramipexole: A dopamine agonist, more suitable for Parkinson's disease directly, not first-line for drug-induced symptoms.
• Amantadine: Can sometimes be used for extrapyramidal symptoms but is not the first choice.

Based on the need to promptly address the symptoms with an anticholinergic, Trihexyphenidyl is the most appropriate first-line treatment for this patient.