What medications are used to treat drug-induced akathisia?

From the Guidelines

Drug-induced akathisia is typically treated by stopping or reducing the offending medication if possible. If that's not feasible, treatment options include:

• Beta blockers: Propranolol 20-40 mg orally, 2-3 times a day, or Metoprolol 25-50 mg orally, 2-3 times a day, for 1-3 months, as suggested by 1.
• Benzodiazepines: may be added to help alleviate symptoms, as recommended by 1.
• Anticholinergics: may not be consistently helpful, but relief has been reported with their use, as noted in 1. It's essential to start with a low dose and gradually increase as needed and tolerated. Close monitoring of symptoms and side effects is crucial. Treatment duration may vary depending on the individual's response and the underlying cause of akathisia. According to 1, lowering the dosage of the antipsychotic medication or switching to another antipsychotic medication may also be considered as treatment options for akathisia.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... Drug-Induced Extrapyramidal Disorders - In treating extrapyramidal disorders due to neuroleptic drugs (e.g., phenothiazines), the recommended dosage is 1 to 4 mg once or twice a day orally, or parenterally.

When extrapyramidal disorders develop soon after initiation of treatment with neuroleptic drugs (e.g., phenothiazines), they are likely to be transient. One to 2 mg of benztropine mesylate tablets two or three times a day usually provides relief within one or two days.

Benztropine mesylate is used to treat drug-induced extrapyramidal disorders, which include akathisia. The recommended dosage is 1 to 4 mg once or twice a day orally, or parenterally. 2

From the Research

Medications for Treating Drug-Induced Akathisia

The following medications are used to treat drug-induced akathisia:

• Beta-blockers, such as propranolol 3, 4, 5, 6, 7
• Anticholinergics, such as biperiden and trihexyphenidyl 3, 6, 7
• Benzodiazepines 3, 4, 5, 7
• Clonidine 3, 4, 5
• Serotonin 2A receptor antagonists, such as mianserin, cyproheptadine, and mirtazapine 5, 6, 7
• Other agents, such as amantadine, buspirone, piracetam, and dopamine depleters 3, 4

Treatment Approach

The treatment approach for drug-induced akathisia typically involves:

• Stopping the offending agent (if possible) 3, 4, 6, 7
• Lowering the dose of the offending agent 3, 4, 6, 7
• Switching to a lower potency neuroleptic or a different antipsychotic 3, 4, 7
• Adding a rescue agent, such as a beta-blocker, anticholinergic, or benzodiazepine 3, 4, 5, 6, 7