REMOXIPRIDE IN THE TREATMENT OF LEVODOPA-INDUCED PSYCHOSIS

Levodopa-induced psychotic symptoms frequently complicate the manageme nt; of patients with Parkinson's disease (PD). We examined the efficac y and tolerability of a novel antipsychotic, remoxipride, in this popu lation. This was a 7-week, open-label pilot evaluation of patients wit h moderate to severe PD and levodopa-induced psychotic symptoms of st least 2 months' duration. The patients were recruited at the Movement Disorders Clinic, The Toronto Hospital, a tertiary referral center, Af ter 1 week of baseline observation, the patients received remoxipride, 25 mg, three times a day orally, with the dose increasing by 25 to 50 mg each week as tolerated. The outcome measures included the Brief Ps ychiatric Rating Scale (BPRS), the Clinical Global impressions (CGI) s cale, and the United Parkinson's Disease Rating Scale. Adverse symptom s were elicited by an open-ended questionnaire and a symptom checklist , Six men and three women aged 69.3 +/- 9 years received remoxipride 1 47 +/- 57 mg/day. Total BPRS score decreased modestly in eight of nine subjects, and there was a statistically significant improvement of me ntal status as indicated by the CGI scale score, which decreased from 3.8 +/- 0.4: at baseline to 2.4 +/- 1.3 at last rating (p < 0.05; Wilc oxon signed rank test), The motor performance deteriorated somewhat in two subjects, whereas the rest showed no appreciable change. The most common adverse effects included tremor, rigidity, akathisia, and hype rsalivation. Remoxipride treatment reduced psychotic symptoms in eight of nine subjects while having no appreciable effect on the parkinsoni an status of seven of nine subjects.