IT Quiz Answer – Jun 6, 2024

For patients with medication-induced psychosis while on CSAI, the first step in treatment is to eliminate medications that may be contributing to this. 

Which of the following is the recommended order for tapering these medications? 

a. Amantadine, trihexyphenidyl, istradefylline, rotigotine
b. Trihexyphenidyl, rotigotine, istradefylline, amantadine
c. Trihexyphenidyl, amantadine, istradefylline, rotigotine
d. Rotigotine, trihexyphenidyl, amantadine, istradefylline  
e. Trihexyphenidyl, istradefylline, rotigotine, istradefylline

Explanation: Trihexyphenidyl, amantadine, istradefylline, followed by rotigotine is the correct order. There are many Parkinson’s disease medications that can cause or contribute to psychosis as patients advance through their disease. Of these, anticholinergic medications, like trihexyphenidyl, are the worst offenders. Amantadine has anticholinergic side effects and a high-risk for psychotic side effects, as does istradefylline. Rotigotine can contribute to the high dopamine level, but also can help patients on CSAI therapy to move around more easily at night so this should be tapered last.

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