Acute laryngeal dystonia: drug-induced respiratory failure related to antipsychotic medications

Nathan Collins

doi:10.29245/2572.942x/2017/1.1167

Abstract

Acute laryngeal dystonia (ALD) is a drug-induced dystonic reaction that can lead to acute respiratory failure and is potentially life-threatening if unrecognized. It was first reported in 1978 when two individuals were noticed to develop difficulty breathing after administration of haloperidol. Multiple cases have since been reported with the use of first generation antipsychotics (FGAs) and more recently second-generation antipsychotics (SGAs). Acute dystonic reactions (ADRs) have an occurrence rate of 3%-10%, but may occur more frequently with high potency antipsychotics. Younger age and male sex appear to be the most common risk factors, although a variety of metabolic abnormalities and illnesses have also been associated with ALD as well. The diagnosis of ALD can go unrecognized as other causes of acute respiratory failure are often explored prior to ALD. The exact mechanism for ALD remains unclear, yet evidence has shown a strong correlation with extrapyramidal symptoms (EPS) and dopamine receptor blockade. Recognition and appropriate management of ALD can prevent significant morbidity and mortality.

Highlights

Acute laryngeal dystonia (ALD) is a life-threatening drug-induced dystonic reaction most commonly related to the administration of an antipsychotic medication
ALD is a type of acute dystonic reaction that occurs amongst other extrapyramidal symptoms (EPS) characterized by laryngospasm leading to respiratory compromise that requires immediate medical attention
first generation antipsychotics (FGAs) have classically been thought to produce EPS more frequently second-generation antipsychotics (SGAs) owing to the higher affinity to dopamine receptors. This thought was based on studies comparing side effects of FGAs to clozapine, the initial SGA proven to be efficacious in the treatment of schizophrenia but with lower binding affinity to the D2-receptor and lower incidence of Acute dystonic reactions (ADRs)

Summary

Introduction

ALD is a life-threatening drug-induced dystonic reaction most commonly related to the administration of an antipsychotic medication. This article will provide an overview of acute dystonia, ALD, including epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, management, and the medications associated with the occurrence of ALD. The acute timing in which ADRs typically occur support this theory, it wouldn’t explain the occurrence of delayed dystonic reactions that have been reported.

Results

Conclusion