Atypical neuroleptics have a significantly lower risk of causing TD than conventional neuroleptics, for which the risk ranges from 13 to 20 percent. The lower risk associated with atypical neuroleptics may be attributed to their higher affinity for mesolimbic D 4 and D3 dopamine receptors rather than striatal D2 dopamine receptors. Atypical neuroleptics include clozapine, resperidone, and the recently approved olanzapine. When withdrawal of the agent that causes TD is not possible, replacing traditional neuroleptics with atypical neuroleptics should be considered. If the patient is also taking stimulants and anticholinergics, eliminating them may alleviate dyskinesias.
Reserpine is the treatment of choice for choreatic tardive dyskinesia.
Elderly people are less likely to tolerate this approach because of orthostatic hypotension. Long-term use of reserpine is also associated with an approximate 15 percent incidence of depression. GABAergic strategies are particularly helpful in patients with tardive dystonia, who can also benefit from anticholinergic therapy and botulinum toxin injections that target the muscles most affected.