L-Type Calcium Channel Blockers, Extrapyramidal Symptoms, and Delirium: A Systematic Review of Case Reports

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INTRODUCTION: L-type voltage-gated calcium channels on dopaminergic neurons can regulate mental status and motor control. The potential of L-type calcium channel blockers (CCBs) to induce extrapyramidal symptoms (EPS) and delirium is scantily studied. METHODOLOGY: A systematic review was conducted from June 2024 to August 2024 using Medline and Scopus on the published cases of EPS, delirium, and psychosis with CCBs. RESULTS: Out of 6908 articles screened, 20 studies involving 23 patients were selected. Fourteen cases of EPS (8 females) and nine cases of delirium or psychosis (6 males) were noticed. Nearly 80% of cases were reported in patients 60 years and above. EPS appeared after 1 day to 8.5 years of CCB administration and Parkinsonism was the commonest phenotype occurring after a median (Q1-Q3) time of 90 (60-360) days. The dihydropyridine (DHPs) class, particularly amlodipine, was implicated in the majority (n=8, 57.1%). Delirium was reported after a few hours to 7 days and psychosis was the commonest manifestation. Nifedipine (n=3), and diltiazem (n=4) were the common culprits. Nearly all patients improved after drug discontinuation, with a median recovery time of 14 days for EPS and 2 days for delirium. CONCLUSION: L-type CCBs can induce EPS and delirium manifesting largely as psychosis. Older females might be the common victims of EPS and older males might be prone to delirium. Most cases have been associated with the dihydropyridine class and have been reversible. Prospective and well-controlled studies are needed to annotate the possible role of L-type CCBs in movement and mood disorders.

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