Akathisia
Encyclopedia
Akathisia, or acathisia, is a syndrome characterized by unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless (hence the word's origin in Ancient Greek
: from - kathízein - "to sit" with a privative a
as prefix
expressing negation or absence; literally meaning inability to sit). It can be a side effect
of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine
and chlorpromazine
), thioxanthenes (such as flupenthixol and zuclopenthixol
) and butyrophenones (such as haloperidol
(Haldol)), piperazines (such as ziprasidone
), antiemetics (such as metoclopramide
and promethazine
), and stimulants (such as antidepressants and amphetamines). Akathisia can also, to a lesser extent, be caused by Parkinson's disease
and related syndromes, and likely other neurological diseases. However, this may be due more to the drugs used in treatment such as sinemet (l-dopa
) and less with the Parkinson's disease itself. Another major cause is withdrawal from most any physical addiction
, for example, in benzodiazepine withdrawal syndrome
. It was discovered that akathisia involves increased levels of the neurotransmitter norepinephrine
, which is associated with mechanisms that regulate aggression
, alertness
, and arousal
. Though no further research has been done of yet, it may also be involved with disrupted NMDA
channels in the brain, which have both synergistic and regulatory effects on norepinephrine.
Akathisia may range in intensity from a sense of disquiet or anxiety
, to severe discomfort, particularly in the knees. Patients typically pace for hours because the pressure on the knees reduces the discomfort somewhat; once their knees and legs become fatigued, they sit or lie down, which is to say that akathisia is as bad as very tired limbs. At high doses or with potent drugs such as haloperidol
(Haldol) or chlorpromazine
(Thorazine/Largactil), the feeling lasts all day from awakening to sleep. The anticholinergic
procyclidine reduces neuroleptic-induced akathisia to a certain degree as well as preventing muscle stiffness which is something different and is practically eliminated with this medication. The anxiety or sense of disquiet is actually something in the mind, a side effect that occurs before ( at lower doses than) akathisia in the knees, which leaves the patient unable to do anything that requires concentrated mental, he has the feeling that passing the time is uncomfortable. It is the opposite to when one is doing something interesting or enjoyable, and appears to be a result of the medication's action on dopaminergic receptors. Some doctors report an anti-axiety drug such as clonazepam
helps this. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture. Many patients describe symptoms of neuropathic pain
akin to fibromyalgia
and restless legs syndrome
. Although these side effects disappear quickly and remarkably when the medication is stopped, tardive, or late-persisting akathisia may go on long after the offending drug is discontinued, sometimes for a period of years—unlike the related tardive dyskinesia
, which can be permanent. Considering that this is rare, it must also be noted that it is not unheard of that patients are medicated or given higher doses against their knowledge.
The presence and severity of akathisia can be measured using the Barnes Akathisia Scale
.
The term was coined before the introduction of antipsychotics by the Czech neuropsychiatrist
Ladislav Haskovec (1866–1944) who described the phenomenon in 1901.
. Interestingly, in some people the opposite response to SSRIs occurs, in the form of emotional blunting; but sufficient clinical research has not yet been made in this area.
Jack Henry Abbot (1981), a convicted murderer and author, described the effects of akathisia produced by antipsychotic drugs when given without the necessary medication for side effects (e.g. procyclidine) as may occur in prison and even sometimes hospitals:
Patients who suffer from neuroleptic-induced akathisia often react by refusing treatment
. At the extreme end, patients who have been treated with neuroleptic antipsychotics for psychotic episodes or prochlorperazine for nausea may rarely run away from hospitals or emergency rooms due to this disconcerting sensation.
medications, but has other causes as well:
The 2006 UK study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)". The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia
. Healy, et al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can "exacerbate psychopathology
." The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebo
s showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).
. The first-line treatment of akathisia is usually propranolol. Benzodiazepines such as clonazepam
are also effective to a certain degree. Benztropine
and trihexyphenidyl
can also be used.
One study showed that vitamin B6
is effective for the treatment of neuroleptic-induced akathisia.
N-acetyl cysteine also showed a positive effect on akathisia in an RCT.
Ancient Greek
Ancient Greek is the stage of the Greek language in the periods spanning the times c. 9th–6th centuries BC, , c. 5th–4th centuries BC , and the c. 3rd century BC – 6th century AD of ancient Greece and the ancient world; being predated in the 2nd millennium BC by Mycenaean Greek...
: from - kathízein - "to sit" with a privative a
Privative a
In Ancient Greek grammar, privative a is the prefix a- that expresses negation or absence . It is derived from a Proto-Indo-European syllabic nasal *, the zero ablaut grade of the negation *ne, i.e. /n/ used as a vowel...
as prefix
Prefix
A prefix is an affix which is placed before the root of a word. Particularly in the study of languages,a prefix is also called a preformative, because it alters the form of the words to which it is affixed.Examples of prefixes:...
expressing negation or absence; literally meaning inability to sit). It can be a side effect
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine
Perphenazine
Perphenazine is a typical antipsychotic drug. Chemically, it is classified as a piperazinyl phenothiazine. It has been in clinical use for decades....
and chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
), thioxanthenes (such as flupenthixol and zuclopenthixol
Zuclopenthixol
Zuclopenthixol , also known as zuclopentixol, is a typical antipsychotic drug of the thioxanthene class...
) and butyrophenones (such as haloperidol
Haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
(Haldol)), piperazines (such as ziprasidone
Ziprasidone
Ziprasidone was the fifth atypical antipsychotic to gain FDA approval . In the United States, Ziprasidone is Food and Drug Administration approved for the treatment of schizophrenia, and the intramuscular injection form of ziprasidone is approved for acute agitation in schizophrenic patients...
), antiemetics (such as metoclopramide
Metoclopramide
Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...
and promethazine
Promethazine
Promethazine is a first-generation antihistamine of the phenothiazine family. The drug has anti-motion sickness, antiemetic, and anticholinergic effects, as well as a strong sedative effect and in some countries is prescribed for insomnia when benzodiazepines are contraindicated...
), and stimulants (such as antidepressants and amphetamines). Akathisia can also, to a lesser extent, be caused by Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
and related syndromes, and likely other neurological diseases. However, this may be due more to the drugs used in treatment such as sinemet (l-dopa
Dopa
Dopa or DOPA can refer to:* L-DOPA , used in the treatment of Parkinson's disease* D-DOPA, a chemical compound related to L-DOPA* Dopa, an angel in Enochian* Deleting Online Predators Act of 2006...
) and less with the Parkinson's disease itself. Another major cause is withdrawal from most any physical addiction
Addiction
Historically, addiction has been defined as physical and psychological dependence on psychoactive substances which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.Addiction can also be viewed as a continued involvement with a substance or activity...
, for example, in benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or during dosage reductions...
. It was discovered that akathisia involves increased levels of the neurotransmitter norepinephrine
Norepinephrine
Norepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...
, which is associated with mechanisms that regulate aggression
Aggression
In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...
, alertness
Alertness
Alertness is the state of paying close and continuous attention, being watchful and prompt to meet danger or emergency, or being quick to perceive and act. It is related to psychology as well as to physiology...
, and arousal
Arousal
Arousal is a physiological and psychological state of being awake or reactive to stimuli. It involves the activation of the reticular activating system in the brain stem, the autonomic nervous system and the endocrine system, leading to increased heart rate and blood pressure and a condition of...
. Though no further research has been done of yet, it may also be involved with disrupted NMDA
NMDA
N-Methyl-D-aspartic acid or N-Methyl-D-aspartate is an amino acid derivative which acts as a specific agonist at the NMDA receptor mimicking the action of glutamate, the neurotransmitter which normally acts at that receptor...
channels in the brain, which have both synergistic and regulatory effects on norepinephrine.
Akathisia may range in intensity from a sense of disquiet or anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, to severe discomfort, particularly in the knees. Patients typically pace for hours because the pressure on the knees reduces the discomfort somewhat; once their knees and legs become fatigued, they sit or lie down, which is to say that akathisia is as bad as very tired limbs. At high doses or with potent drugs such as haloperidol
Haloperidol
Haloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
(Haldol) or chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
(Thorazine/Largactil), the feeling lasts all day from awakening to sleep. The anticholinergic
Anticholinergic
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An example of an anticholinergic is dicycloverine, and the classic example is atropine....
procyclidine reduces neuroleptic-induced akathisia to a certain degree as well as preventing muscle stiffness which is something different and is practically eliminated with this medication. The anxiety or sense of disquiet is actually something in the mind, a side effect that occurs before ( at lower doses than) akathisia in the knees, which leaves the patient unable to do anything that requires concentrated mental, he has the feeling that passing the time is uncomfortable. It is the opposite to when one is doing something interesting or enjoyable, and appears to be a result of the medication's action on dopaminergic receptors. Some doctors report an anti-axiety drug such as clonazepam
Clonazepam
Clonazepamis a benzodiazepine drug having anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. It is marketed by Roche under the trade name Klonopin in the United States and Rivotril in Australia, Brazil, Canada and Europe...
helps this. When misdiagnosis occurs in antipsychotic neuroleptic-induced akathisia, more antipsychotic neuroleptics may be prescribed, potentially worsening the symptoms. High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture. Many patients describe symptoms of neuropathic pain
Neuropathic pain
Neuropathic pain results from lesions or diseases affecting the somatosensory system. It may be associated with abnormal sensations called dysesthesia, which occur spontaneously and allodynia that occurs in response to external stimuli. Neuropathic pain may have continuous and/or episodic ...
akin to fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
and restless legs syndrome
Restless legs syndrome
Restless legs syndrome or Willis-Ekbom disease is a neurological disorder characterized by an irresistible urge to move one's body to stop uncomfortable or odd sensations. It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs...
. Although these side effects disappear quickly and remarkably when the medication is stopped, tardive, or late-persisting akathisia may go on long after the offending drug is discontinued, sometimes for a period of years—unlike the related tardive dyskinesia
Tardive dyskinesia
Tardive dyskinesia is a difficult-to-treat form of dyskinesia that can be tardive...
, which can be permanent. Considering that this is rare, it must also be noted that it is not unheard of that patients are medicated or given higher doses against their knowledge.
The presence and severity of akathisia can be measured using the Barnes Akathisia Scale
Barnes Akathisia Scale
The Barnes Akathisia Scale is a rating scale that is administered by physicians to assess the severity of drug-induced akathisia. The Barnes Akathisia Scale is the most widely used rating scale for akathisia. This scale includes objective and subjective items such as the level of the patient's...
.
The term was coined before the introduction of antipsychotics by the Czech neuropsychiatrist
Neuropsychiatry
Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
Ladislav Haskovec (1866–1944) who described the phenomenon in 1901.
Description
Reports of akathisic states can be found in the medical literature before the advent of neuroleptics. Healy, et al. (2006), described the following regarding akathisia: tension, insomnia, a sense of discomfort, motor restlessness, and marked anxiety and panic. Increased labile affect can result, such as weepinessCrying
Crying is shedding tears as a response to an emotional state in humans. The act of crying has been defined as "a complex secretomotor phenomenon characterized by the shedding of tears from the lacrimal apparatus, without any irritation of the ocular structures"...
. Interestingly, in some people the opposite response to SSRIs occurs, in the form of emotional blunting; but sufficient clinical research has not yet been made in this area.
Jack Henry Abbot (1981), a convicted murderer and author, described the effects of akathisia produced by antipsychotic drugs when given without the necessary medication for side effects (e.g. procyclidine) as may occur in prison and even sometimes hospitals:
Patients who suffer from neuroleptic-induced akathisia often react by refusing treatment
Therapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
. At the extreme end, patients who have been treated with neuroleptic antipsychotics for psychotic episodes or prochlorperazine for nausea may rarely run away from hospitals or emergency rooms due to this disconcerting sensation.
Causes
Akathisia is most often seen as a side effect of antipsychoticAntipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medications, but has other causes as well:
- Antipsychotics such as haloperidolHaloperidolHaloperidol is a typical antipsychotic. It is in the butyrophenone class of antipsychotic medications and has pharmacological effects similar to the phenothiazines....
(Haldol), droperidolDroperidolDroperidol is an antidopaminergic drug used as an antiemetic and antipsychotic...
, pimozidePimozidePimozide is an antipsychotic drug of the diphenylbutylpiperidine class. It was discovered at Janssen Pharmaceutica in 1963. It has a high potency compared to chlorpromazine . On a weight basis it is even more potent than haloperidol. It also has special neurologic indications for Tourette syndrome...
, trifluoperazineTrifluoperazineTrifluoperazine is a typical antipsychotic of the phenothiazine chemical class.- Uses :...
, amisulprideAmisulprideAmisulpride , is an atypical antipsychotic used to treat psychosis in schizophrenia and episodes of mania in bipolar disorder. In small doses it is also used to treat depression. It was introduced by Sanofi-Aventis in the 1990s.-Pharmacology:Amisulpride functions primarily as a D2 and D3 receptor...
, risperidoneRisperidoneRisperidone is a second generation or atypical antipsychotic, sold under the trade name . It is used to treat schizophrenia , schizoaffective disorder, the mixed and manic states associated with bipolar disorder, and irritability in people with autism...
, aripiprazoleAripiprazoleAripiprazole is an atypical antipsychotic and antidepressant used in the treatment of schizophrenia, bipolar disorder, and clinical depression...
(Abilify) and asenapineAsenapineAsenapine is a new atypical antipsychotic developed for the treatment of schizophrenia and acute mania associated with bipolar disorder by Schering-Plough after its November 19, 2007 merger with Organon International. Development of the drug, through Phase III trials, began while Organon was still...
(Saphris). Less common in sedating antipsychotics such as zuclopenthixolZuclopenthixolZuclopenthixol , also known as zuclopentixol, is a typical antipsychotic drug of the thioxanthene class...
(Cisordinol) or chlorpromazineChlorpromazineChlorpromazine is a typical antipsychotic...
where anticholinergic and antihistaminergic effects counteract akathisia to a degree. - SSRIsSelective serotonin reuptake inhibitorSelective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...
, such as fluoxetineFluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
(Prozac). It has also been documented with the use of paroxetineParoxetineParoxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...
(Paxil). Akathisia has been studied as the mechanism by which SSRI-induced suicidality occurs. - Other antidepressants, such as venlafaxineVenlafaxineVenlafaxine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. First introduced by Wyeth in 1993, now marketed by Pfizer, it is licensed for the treatment of major depressive disorder , as a treatment for generalized anxiety disorder, and comorbid indications in...
(Effexor), the tricyclicsTricyclic antidepressantTricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade; they are named after their chemical structure, which contains three rings of atoms...
and trazodoneTrazodoneTrazodone is an antidepressant of the serotonin antagonist and reuptake inhibitor class. It is a phenylpiperazine compound...
(Desyrel). - Certain anti-emetic drugs, particularly the dopamineDopamineDopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
blockers, such as metoclopramideMetoclopramideMetoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...
(Reglan), prochlorperazineProchlorperazineProchlorperazine is a dopamine receptor antagonist that belongs to the phenothiazine class of antipsychotic agents that are used for the antiemetic treatment of nausea and vertigo. It is also a highly-potent typical antipsychotic, 10-20x more potent than chlorpromazine...
(Compazine), and promethazinePromethazinePromethazine is a first-generation antihistamine of the phenothiazine family. The drug has anti-motion sickness, antiemetic, and anticholinergic effects, as well as a strong sedative effect and in some countries is prescribed for insomnia when benzodiazepines are contraindicated...
. - Antihistamines, such as cyproheptadineCyproheptadineCyproheptadine , sold under the brand name Periactin, is a first-generation antihistamine with additional anticholinergic, antiserotonergic, and local anesthetic properties.- Indications :...
or diphenhydramineDiphenhydramineDiphenhydramine hydrochloride is a first-generation antihistamine possessing anticholinergic, antitussive, antiemetic, and sedative properties which is mainly used to treat allergies. Like most other first-generation antihistamines, the drug also has a powerful hypnotic effect, and for this reason...
. - OpioidOpioidAn opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
withdrawal. - Barbiturates withdrawal.
- CocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
withdrawal (Mostly in heavy and long-term users). - Amphetamines and any stimulantStimulantStimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
(even coffeeCoffeeCoffee is a brewed beverage with a dark,init brooo acidic flavor prepared from the roasted seeds of the coffee plant, colloquially called coffee beans. The beans are found in coffee cherries, which grow on trees cultivated in over 70 countries, primarily in equatorial Latin America, Southeast Asia,...
and tobaccoTobaccoTobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
). - BenzodiazepineBenzodiazepineA benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
, and alcoholAlcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
. - Chondromalacia patellaeChondromalacia patellaeChondromalacia patellae is a term that goes back eighty years. It originally meant "soft cartilage under the knee cap," a presumed cause of pain at the front and especially inner side of the knee. This condition often affects young, otherwise healthy individuals.Chondromalacia is due to an...
, resulting in discomfort when knees are bent. - Serotonin syndromeSerotonin syndromeSerotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs...
.
The 2006 UK study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as "agitation, emotional lability, and hyperkinesis (overactivity)". The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia
Dyskinesia
Dyskinesia is a movement disorder which consists of effects including diminished voluntary movements and the presence of involuntary movements, similar to tics or choreia. Dyskinesia can be anything from a slight tremor of the hands to uncontrollable movement of, most commonly, the upper body but...
. Healy, et al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can "exacerbate psychopathology
Psychopathology
Psychopathology is the study of mental illness, mental distress, and abnormal/maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes...
." The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
s showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).
Treatment
Akathisia can be reduced by withdrawing or decreasing the dose of the causative agent, or by administering other drugs, though the latter proves many times to be counter-productive unless the person administering and managing the drugs has an extensive knowledge of neurobiology and pharmacokineticsPharmacokinetics
Pharmacokinetics, sometimes abbreviated as PK, is a branch of pharmacology dedicated to the determination of the fate of substances administered externally to a living organism...
. The first-line treatment of akathisia is usually propranolol. Benzodiazepines such as clonazepam
Clonazepam
Clonazepamis a benzodiazepine drug having anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties. It is marketed by Roche under the trade name Klonopin in the United States and Rivotril in Australia, Brazil, Canada and Europe...
are also effective to a certain degree. Benztropine
Benztropine
Benzatropine , also known as benztropine , is an anticholinergic marketed under the trade name Cogentin which is used in the treatment of Parkinson's disease, parkinsonism, akathisia, and dystonia.- Indications :...
and trihexyphenidyl
Trihexyphenidyl
Trihexyphenidyl , also known as benzhexol, is an antiparkinsonian agent of the antimuscarinic class. It has been in clinical usage for decades...
can also be used.
One study showed that vitamin B6
Vitamin B6
Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Several forms of the vitamin are known, but pyridoxal phosphate is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation...
is effective for the treatment of neuroleptic-induced akathisia.
N-acetyl cysteine also showed a positive effect on akathisia in an RCT.