the information i posted yesterday was slightly off -
for Sinemet CR as of 2002 (the most recent i could
find), the total word count is 4,800 and the
dykinesia-related parts are 208 - or 4.3%.

two of the older neuroleptics look like this: Navane,
with 2,500 words total and 540 dyskinesia, 21.6%; and
Moban, with 2737 total and 633 dyskinesia, 23.1%.

but the newer neuroleptic kind of skews things because
it is over 12,000 words long, with 434
dyskinesia-related.

however, for those of you who are interested, what the
labels say is at least as interesting as how much they
say. so below i am pasting in the Sinemet CR
dyskinesia-related labeling followed by the Zyprexa
(olanzapine) dyskinesia-related labeling.

Zyprexa is the newest of the three neuroleptics i
could find and therefore the least likely to cause
TDs, and the softest of the three neuroleptics in
terms of warnings, and yet please note that the
placebo group experienced the most dykinetic events at
4% (with the three different zyprexa dosage groups
reporting 0%, 1% and 2%) so who knows what that means.

Also note that where dyskinesias are referred to as
common with Sinemet and indeed they are three times
more likely than the next most frequently occurring
adverse reaction, nausea, they are classified as
infrequent with Zyprexa.

-----------------------------------------------------------
SINEMET CR 04/02 (total 4802 words, dysk 208 - 4.3%)

PHARMACODYNAMICS (this section is really talking about
Sinemet but i am including it anyway)
Patients treated with levodopa therapy for Parkinson's
disease may develop motor fluctuations characterized
by end-of-dose failure, peak dose dyskinesia, and
akinesia. The advanced form of motor fluctuations
(‘on-off’ phenomenon) is characterized by
unpredictable swings from mobility to immobility.
Although the causes of the motor fluctuations are not
completely understood, in some patients they may be
attenuated by treatment regimens that produce steady
plasma levels of levodopa.

WARNINGS (2nd paragraph)
Carbidopa does not decrease adverse reactions due to
central effects of levodopa. BY permitting more
levodopa to reach the brain, particularly when nausea
and vomiting is not a dose-limiting factor, certain
adverse CNS effects, e.g., dyskinesias, will occur at
lower dosages and sooner during therapy with SINEMET
CR (Carbidopa-Levodopa) Sustained-Release than with
levodopa alone.

Patients receiving SINEMET CR may develop increased
dyskinesias compared to SINEMET (Carbidopa-Levodopa).
Dyskinesias are a common side effect of
carbidopa-levodopa treatment. The occurrence of
dyskinesias may require dosage reduction.

DRUG INTERACTIONS
There have been rare reports of adverse reactions,
including hypertension and dyskinesia, resulting from
the concomitant use of tricyclic antidepressants and
carbidopa-levodopa preparations.

ADVERSE EXPERIENCES TABLE - the following are the two
most common adverse reactions in clinical trials -
which means they weren’t more than a couple of years
long, though naturally it doesn’t say how long they
were.

Dyskinesias 16.5%
Nausea 5.5%

DOSAGE & ADMINISTRATION
Patients should be monitored closely during the dose
adjustment period, particularly with regard to
appearance or worsening of involuntary movements,
dyskinesias or nausea.

--------------------------------------------------------

ZYPREXA neuroleptic  2003 (total words 12,680, dysk
435)

WARNINGS (last of four warnings)
Tardive Dyskinesia — A syndrome of potentially
irreversible, involuntary, dyskinetic movements may
develop in patients treated with antipsychotic drugs.
Although the prevalence of  the syndrome appears to be
highest among the elderly, especially elderly women,
it is impossible  to rely upon prevalence estimates to
predict, at the inception of antipsychotic treatment,
which  patients are likely to develop the syndrome.
Whether antipsychotic drug products differ in their
potential to cause tardive dyskinesia is unknown.

The risk of developing tardive dyskinesia and the
likelihood that it will become irreversible are
believed to increase as the duration of treatment and
the total cumulative dose of antipsychotic  drugs
administered to the patient increase. However, the
syndrome can develop, although much  less commonly,
after relatively brief treatment periods at low doses.


There is no known treatment for established cases of
tardive dyskinesia, although the syndrome  may remit,
partially or completely, if antipsychotic treatment is
withdrawn. Antipsychotic  treatment, itself, however,
may suppress (or partially suppress) the signs and
symptoms of the  syndrome and thereby may possibly
mask the underlying process. The effect that
symptomatic  suppression has upon the long-term course
of the syndrome is unknown.

Given these considerations, olanzapine should be
prescribed in a manner that is most likely to
minimize the occurrence of tardive dyskinesia. Chronic
antipsychotic treatment should generally be  reserved
for patients (1) who suffer from a chronic illness
that is known to respond to  antipsychotic drugs, and
(2) for whom alternative, equally effective, but
potentially less harmful  treatments are not available
or appropriate. In patients who do require chronic
treatment, the  smallest dose and the shortest
duration of treatment producing a satisfactory
clinical response  should be sought. The need for
continued treatment should be reassessed periodically.


If signs and symptoms of tardive dyskinesia appear in
a patient on olanzapine, drug  discontinuation should
be considered. However, some patients may require
treatment with  olanzapine despite the presence of the
syndrome.

For specific information about the warnings of lithium
or valproate, refer to the WARNINGS  section of the
package inserts for these other products.

ADVERSE EVENTS INCIDENCE
if i am reading this correctly, 4% of the people
taking placebo reported dyskinetic events, where 0%,
2%, and 1% were reported by the folks taking the
zyprexa (three different dosage groups)

Other Adverse Events Observed During the Clinical
Trial Evaluation of Olanzapine Following is a list of
terms that reflect treatment-emergent adverse events
reported by patients treated with olanzapine (at
multiple doses ?1 mg/day) in clinical trials (8661
patients, 4165 patient-years of exposure).

Nervous system - there are three categories -
frequent, infrequent and rare - tardive dyskinesia are
classified as rare




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