Levosulpiride Induced Parkinsonism and Other Movement Disorders

Drug induced Parkinsonism; the second leading cause of Parkinsonism remains often under recognised. Main culprits like neuroleptics get scrutinized while drugs like levosulpiride go unsupervised many a time. Levosulpiride is a enantiomer of the sulpiride with antidopaminergic activity at D2 receptor and agonistic activity at 5HT4 receptors. Due to inhibition of D2 receptors in the gastrointestinal system, there is increased gastric and gall bladder mobility as well as increased tone of lower esophageal sphincters. Central action at area postrema also renders helping hand as a potent antiemetic. It’s used in dyspepsia, gastroparesis, burning mouth syndrome, cataplexy, acute labrynthine dysfunction, glycemic control and premature ejaculation. Psychiatric illness such as depressive disorders, somatoform disorder and positive as well as negative symptoms in schizophrenia recommends levosulpiride use. Drug remains unmetabolised and excreted in urine unchanged which reduces the drug interactions. No teratogenic, mutagenic or oncogenic potential are found in animal experiments but no studies have been confident about its use in pregnancy. As the drug is excreted in breast milk it’s highly advised to be restricted in lactating mothers.