Deliberate use is made of the direct effect of neuromuscular blockers such as atracurium or vecuronium as an adjunct to anaesthesia in surgery, as these will relax skeletal/striated muscle allowing intubation. Lasting dysphagia is uncommon as the drug’s effect usually wears off quickly. Local anaesthetics such as lidocaine can create a temporary sensation of impaired or uncontrolled swallowing.^11,23

Antipsychotics used long term are associated with dysphagia development. Antidopaminergic activity may lead to extrapyramidal side effects affecting movement (similar to what happens in Parkinson’s disease) and tardive dyskinesia. Movement can be affected in the mouth, jaws, and larynx with resulting dysphagia. The effect can also include the LOS not opening fully.^2,24,25,26

Tardive dyskinesia is characterised by sudden, irregular involuntary movements in the face or body, and can involve the lips, tongue and/or jaw. This can make chewing, swallowing or talking difficult.^24,27,28

Dysphagia is recognised with first-generation antipsychotics such as haloperidol and phenothiazines, but there are case reports with second generation antipsychotics such as risperidone, olanzapine, quetiapine, and aripiprazole. Other drugs with the potential to cause extrapyramidal side effects or parkinsonian symptoms include antiemetics, lithium, SSRIs, SNRIs, tricyclics, valproate, and methyldopa.^24,26,27

CNS depressants causing drowsiness or confusion have the potential to increase dysphagia risk by decreasing awareness and voluntary muscle action, while impeding the initiation of swallowing. Drugs with these effects include benzodiazepines, skeletal muscle relaxants, antiepileptics, barbiturates, opiates and other sedatives.¹¹