EPS Tremors On Clopixol

[Chip (OP)]

🧠 Why Does My Hand Shake on Clopixol?

🔬 Root Cause: Extrapyramidal Symptoms (EPS)

Clopixol (Zuclopenthixol) is a first-generation antipsychotic known for strong dopamine D2 receptor blockade, especially in the nigrostriatal pathway — the brain circuit responsible for movement control.

Mechanism:
- ↓ Dopamine in motor regions
- ↑ Parkinsonism-like symptoms:
  - 🫱 Hand tremors
  - 🪑 Slowed movement
  - 💀 Muscle stiffness
  - 🧍 Stooped posture


🧬 Why It Happens After Long-Term Olanzapine Use

- 25 years of Olanzapine = adapted D2 sensitivity
- Clopixol = stronger D2 blocker → dopamine crash
- Result: EPS symptoms like tremors, rigidity, bradykinesia


📉 EPS Risk Comparison

Olanzapine: Low–Moderate 
Clopixol (oral): Moderate–High 
Clopixol Depot: High 


✅ How to Manage the Hand Tremor

1. Dose Adjustments
- Lower Clopixol dose
- Try AM/PM split dosing

2. Add-on Medications
- 🧠 Benzatropine (Cogentin)
- 🚶 Procyclidine or Trihexyphenidyl
- 💓 Propranolol (for tremors)
- 🧃 Vitamin B6
- 💊 Amantadine (dopaminergic)


🚨 When to Worry

Seek help if:
- Tremors get worse
- You feel internal anxiety (akathisia)
- Neck spasms, jaw tension, tongue rolling


🔄 Long-Term Solutions

Try:
- Atypicals with less EPS: Aripiprazole, Quetiapine, Lurasidone
- Depot Clopixol? Use very low dose and protect with anticholinergics


💬 Summary

Hand tremors = Clopixol's D2 blockade overcorrecting your dopaminergic system after 25 years on Olanzapine. It's treatable, but act early to prevent permanent damage.