Table 1.

Summary of proposed stepwise treatment algorithm for tardive dyskinesia (TD)

1.	Recognition and diagnosis of TD
2.	Documentation of severity, distribution, and phenomenology of TD (AIMS examination)
3.	Differential diagnosis and laboratory investigation
4.	Neurological consultation (for diagnostic dilemmas, atypical, or severe cases)
5.	Discussion of treatment options with patient and caregivers
6.	Review of antipsychotic (dopamine-receptor antagonist) treatment
	a. Patients who can be safely tapered off treatment if alternative therapies are available
	b. Patients who require antipsychotic maintenance treatment
	i. Maintain current treatment
	ii. Switch to a second SGA or clozapine
7.	Review of anticholinergic treatment
	a. Patients who can be safely tapered off treatment
	b. Maintain or reduce dosages in patients who require anticholinergic treatment for acute movement disorders or tardive dystonia
	c. Consider amantadine in patients who require concurrent treatment for acute movement disorders and TD
8.	Specific anti-dyskinetic treatment on an individualized basis
	a. Valbenazine: US FDA approved for treatment of TD in adults
	b. Deutetrabenazine: US FDA approved for treatment of TD in adults and chorea associated with Huntington’s disease
	c. Positive findings but evidence is insufficient for FDA approval: tetrabenazine, amantadine, botulinum toxin (specific benefit for focal or segmental tardive dystonia), levetiracetam, clonazepam, zonisamide, piracetam, propranolol, Gingko biloba extract, and vitamin B6

Notes: Copyright ©2017. Taylor & Francis Ltd. Reproduced from Caroff SN, Campbell EC, Carroll B. Pharmacological treatment of tardive dyskinesia: recent developments. Expert Rev Neurother. 2017;17:871–881.⁷⁵