From the Guidelines
The treatment for acute dystonic reaction should primarily involve anticholinergic medications, with the goal of rapidly relieving symptoms and preventing recurrence, as recommended by the American Psychiatric Association 1. The most effective treatment approach for acute dystonic reaction involves administering anticholinergic medications, such as benztropine (Cogentin) or diphenhydramine (Benadryl), to rapidly relieve symptoms.
- For adults, benztropine 1-2 mg can be administered intramuscularly or intravenously, while diphenhydramine 25-50 mg can be given intravenously or intramuscularly.
- For children, diphenhydramine 1 mg/kg up to 50 mg is preferred. After the acute episode resolves, oral anticholinergic medication should be continued for 2-3 days to prevent recurrence, such as benztropine 1-2 mg twice daily or diphenhydramine 25-50 mg three to four times daily 1. It is essential to discontinue or reduce the dose of the offending agent, typically antipsychotics, antiemetics, or other dopamine-blocking drugs, if possible. Patients should be monitored for anticholinergic side effects, including dry mouth, blurred vision, urinary retention, and confusion, which are usually mild and transient 1. The American Psychiatric Association recommends treating patients who have acute dystonia associated with antipsychotic therapy with an anticholinergic medication 1. This approach prioritizes reducing morbidity, mortality, and improving quality of life for patients experiencing acute dystonic reactions.
From the FDA Drug Label
In acute dystonic reactions, 1 to 2 mL of the injection usually relieves the condition quickly. The treatment for acute dystonic reaction is 1 to 2 mL of benztropine mesylate injection which usually provides quick relief 2.
- The dose can be repeated if the condition returns.
- The recommended dosage is 1 to 4 mg once or twice a day parenterally.
- Dosage must be individualized according to the need of the patient.
From the Research
Treatment Options for Acute Dystonic Reaction
The treatment for acute dystonic reaction typically involves the use of anticholinergic or antidopaminergic medications.
- Anticholinergic drugs, such as benztropine mesylate 3 or biperiden 4, have been shown to be effective in treating acute dystonic reactions.
- Diphenhydramine, an antihistamine with anticholinergic properties, can also be used to treat acute dystonic reactions, although it has been reported to cause dystonic reactions in some cases 5.
- In some cases, benzodiazepines, such as diazepam, may be used to treat acute dystonic reactions 5.
Medication Administration
These medications can be administered intramuscularly or intravenously, depending on the severity of the reaction and the patient's condition.
- Benztropine mesylate has been shown to be effective in reducing recovery time in patients with acute dystonic reactions 3.
- Biperiden has been used to treat acute dystonic reactions, particularly those induced by metoclopramide 4.
Important Considerations
It is essential to monitor patients for extrapyramidal side effects, such as dystonic reactions, when administering medications that can cause these symptoms, such as metoclopramide 4.