;)
Figure: akathisia, treatments, dopaminergic blocking agents, droperidol, prochlorperazine, metoclopramide, antipsychotic medications, beta blockers, propranolol, mirtazapine, anticholinergic, benztropine, benzodiazepine, amantadine, clonidine, mianserin, cyproheptadine
FigureAkathisia is an uncomfortable side effect of dopaminergic blocking agents such as droperidol, prochlorperazine, metoclopramide, and various antipsychotic medications. This occurs in a dose-dependent fashion.
Some patients become so restless and agitated that they leave the emergency department against medical advice. The limited evidence shows that first-line agents might include:
- Beta blockers such as propranolol 40-80 mg/day.
- Mirtazapine (a tetracycline antidepressant) 15 mg/day.
- Anticholinergic such as benztropine 1.5-8 mg/day if there is evidence of Parkinsonism.
Second-line agents include:
- Benzodiazepine.
- Amantadine (dopamine agonist) or clonidine (alpha blocker).
- Mianserin or cyproheptadine (tetracycline antidepressants).
Do not re-dose the medication if akathisia occurs after a single dose, and consider giving propranolol and a benzodiazepine to help allay the symptoms.
Read a great review on this in Current Neuropharmacology. (2017;15[5]:789; https://bit.ly/3Jjn89u.)
Dr. Linis the founder, CEO, and editor-in-chief of Academic Life in Emergency Medicine (https://www.ALiEM.com) and a professor of emergency medicine at the University of California San Francisco with interests in health professions education and digital scholarship. Follow her on Instagram@MichelleLinMDand on Twitter@M_Lin.
