From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
The maximum dose of propranolol for treating akathisia is typically 120 mg per day, divided into multiple doses. For most patients, treatment usually begins with a lower dose of 10-20 mg taken two to three times daily, which can be gradually increased as needed based on symptom response. Propranolol works quickly, often providing relief within 30-60 minutes of administration, making it useful for acute management of akathisia. This medication is a non-selective beta-blocker that works by blocking peripheral beta-adrenergic receptors, which helps reduce the physical manifestations of akathisia such as restlessness and the urge to move. When prescribing propranolol for akathisia, it's essential to monitor for potential side effects, including hypotension, bradycardia, and bronchospasm, as noted in studies such as 1. The medication should be used with caution in patients with asthma, COPD, diabetes, or heart block.
Some key points to consider when using propranolol for akathisia include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects, especially in patients with certain comorbid conditions
- Considering alternative treatments for akathisia, such as benzodiazepines, anticholinergics, or switching the causative antipsychotic medication, if propranolol is not effective or tolerated, as discussed in 2, 3, and 4
- Being aware of the potential for withdrawal akathisia when discontinuing or reducing certain antipsychotic medications, as highlighted in 1
Given the information from the most recent and highest quality study available, propranolol at a maximum dose of 120 mg per day is recommended for the treatment of akathisia, with careful consideration of the patient's overall clinical picture and potential for side effects, as supported by 1.