Extrapyramidal Side Effects (Extrapyramidal Symptoms)

By Medically reviewed by Hello Doktor Medical Panel


What are Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

Extrapyramidal symptoms (also known as EPS) are a set of side effects that are common with antipsychotic medications, as well as with a few other types of medications. Antipsychotics are prescription medications used to treat psychotic disorders, such as schizophrenia, schizoaffective disorder, or psychotic depression.

Extrapyramidal symptoms are usually divided into different categories. Dyskinesias are movement disorders, while dystonias are muscle tension disorders. “Tardive” symptoms are those that appear during long-term treatment (often after several years). Unlike earlier symptoms, tardive symptoms are more likely to be permanent even after the medication is stopped.

How common are Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

Please discuss with your doctor for further information.


What are the symptoms of Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

The common symptoms of Extrapyramidal Side Effects (Extrapyramidal Symptoms) are:

  • Restlessness and nervous energy shown by pacing, marching, shuffling, or foot-tapping
  • Severe, uncontrolled muscle contractions of your head, neck, trunk, and limbs that cause stiff tongue, twisted neck, or back arching
  • Tremors, stiff posture, or no arm movement when you walk
  • Uncontrolled movements of your tongue, jaw, lips, or face, such as pursing, chewing, or frequent eye blinking
  • Uncontrolled movements of your fingers or toes, head nodding, or pelvic thrusting
  • Fast, irregular breathing with grunts, gasping, or sighing
  • Weak voice, drooling, or little or no facial expression

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Do not stop taking your medicines unless your healthcare provider says it is okay. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

Extrapyramidal Symptoms occur most commonly as side-effects of certain medications that block dopamine functioning, such as the Typical Antipsychotics, less commonly the Atypical Antipsychotics, and very rarely by antidepressants.  Extrapyramidal symptoms are often found in people with Schizophrenia and Bipolar Disorder who use these medications. However, these symptoms can also occur in people with Schizophrenia who have never taken any of these medications.

Risk factors

What increases my risk for Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

Please discuss with your doctor for further information.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How are Extrapyramidal Side Effects (Extrapyramidal Symptoms) diagnosed?

Your doctor may diagnose Extrapyramidal Symptoms using a physical exam.

There are scales available to assess a variety of common movement symptoms. However, since different clusters of symptoms can suggest different treatments, a full exam by a movement specialist may be desired.

How are Extrapyramidal Side Effects (Extrapyramidal Symptoms) treated?

Treatment of these symptoms depends upon the medication that induced them and which symptoms you have.

Your doctor may try decreasing your dose or switching your medication altogether to one that has been shown to have fewer extrapyramidal side effects.

Benzodiazepines are sometimes prescribed to help counteract extrapyramidal side effects, as are anti-parkinsonism drugs called anticholinergics. Antipsychotics block dopamine, which is what causes the extrapyramidal side effects in the first place.

Anticholinergics increase dopamine so it becomes leveled out in your system.

Typical Antipsychotics

Typical antipsychotics are the first generation of antipsychotics and are more likely to have extrapyramidal side effects. The U.S. Food and Drug Administration (FDA) has approved these typical antipsychotics:

  • Thorazine (chlorpromazine)
  • Inapsine (droperidol)
  • Prolixin (fluphenazine)
  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Trilafon (perphenazine)
  • Orap (pimozide)
  • Compazine (prochlorperazine)
  • Navane (thiothixene)
  • Mellaril (thioridazine)
  • Stelazine (trifluoperazine)

Atypical Antipsychotics

Atypical antipsychotics are the newer second-generation of antipsychotics. If you are experiencing extrapyramidal side effects on one of the older, atypical antipsychotics, your doctor may switch you to one of these. FDA-approved atypical antipsychotics include:

  • Abilify (aripiprazole)
  • Saphris (asenapine)
  • Clozaril (clozapine)
  • Fanapt (iloperidone)
  • Zyprexa (olanzapine)
  • Invega (paliperidone)
  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Geodon (ziprasidone)

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage Extrapyramidal Side Effects (Extrapyramidal Symptoms)?

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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Review Date: May 22, 2018 | Last Modified: September 13, 2019