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Neuroleptics: potentially serious swallowing disorders

Swallowing disorders in a patient on neuroleptics could be caused by the medication.

Swallowing disorders take the form of difficulty in swallowing solids or liquids and the sensation that food is stuck and is obstructing the upper digestive tract. A source of discomfort, swallowing disorders can affect patients’ quality of life and have serious, sometimes fatal consequences: aspiration pneumonia, suffocation, death through asphyxia.

A number of reports have highlighted the role of neuroleptics in causing such disorders, confirmed by X-ray examination. Various neuroleptics are implicated and several mechanisms have been cited: sedative effect, dryness of the mouth or, conversely, sialorrhea, extrapyramidal neurological disorders.

Patients at risk are those who have been under treatment for a long time and who suffer from various extrapyramidal disorders, either patients who have recently started taking a neuroleptic drug or who have recently increased the dose.

In a young patient suffering from acute dyskinesia (neurological motor disorder), reducing the dose or even stopping the treatment generally results in cessation of the disorder. In an older patient who has taken neuroleptics for a long time and is suffering from tardive dyskinesia, treatment is a delicate matter, as halting the neuroleptics can aggravate the symptoms.

In a patient suffering from Alzheimer’s disease who is having difficulty eating or who coughs when taking food, the cause could be a neuroleptic and the treatment should be stopped in the patient’s best interests.

©Prescrire January 2011

"Neuroleptics: swallowing disorders" Prescrire Int 2010; 20 (112): 15-17 (pdf, subscribers only).

 
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