(2) Did the adverse event appear after the suspected drug was administered? Result of Naranjo Adverse Drug Reaction Probability Scale for Case A and Case B. Drug-Drug-Induced Akathisia: Two Case Reports, Department of Psychiatry, Korle Bu Teaching Hospital, P. O. Our guide offers strategies to help you or your loved one live better with bipolar disorder. Akathisia may appear as a side effect of the long-term use of antipsychotic medications, Lithium, and some other neuroleptic drugs. The akathisia was managed by reducing her olanzapine 10 mg tablet to 5 mg daily and adding benzhexol 5 mg tablet daily (to be taken when needed) to her treatment regimen. Better still, a facility may go a step further in making the above stated activity part of a bundled care or service to patients with mental disorders. Persisting high plasma concentrations of these medications may have accounted for the development of the akathisia and the long duration in resolution of the symptoms, even when the patient was not adherent to her medications. On day 31, she reported for review with complaints of restlessness and frequent urges to pace around. The information underpins the need for health professionals to consider adverse drug-drug interactions as the probable cause of extrapyramidal side effects experienced by patients on antipsychotics. In severe cases, the thought processes of affected patients may become disorganized and their judgment impaired. For more mental health resources, see our National Helpline Database. In 1998, Lane presented a report on the propensity of selective serotonin reuptake inhibitors (SSRIs) to induce akathisia when combined with antipsychotics. A review of the side effect profiles of the medicines prescribed for Case A and Case B shows that they can all cause symptoms of akathisia [13–17]. Testing a narrow version of the self-medication hypothesis, Relationship of neuroleptic-induced akathisia to drug-induced parkinsonism, Serum iron and ferritin in acute neuroleptic akathisia, Is there a rationale for iron supplementation in the treatment of akathisia? Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. A description of the temporal association between Case A’s presentation, treatment, and resolution of akathisia. This report presents two cases of drug-drug-induced akathisia. An important part of coping with akathisia is managing your medication. If you suspect akathisia, it’s important to see your doctor to get an official diagnosis. If you're feeling alone or frustrated about your symptoms, it can also help to confide in a trusted friend or family member. Case B’s presenting complaints were restlessness, tremor, abdominal discomfort, constipation, and weight gain. The obsessive thoughts used to be one of her complaints before being managed and stabilized on risperidone 2 mg tablet daily, and therefore, the obsessive thoughts could be a symptom of a relapse. This report is to create more awareness about psychotropic-antimicrobial-induced akathisia. On discharge, ciprofloxacin 500 mg tablet every 12 hours for 5 days and fluconazole 150 mg capsule once were added to her medications for the treatment of a urinary tract infection. Objective symptoms are mainly seen in the movement of patients and can be classified as repetitive, purposeful, stereotypical, or suppressible. She presented for review on day 28 with complaints of persisting distressing restlessness, weight gain, and stomach upset. A review of the evidence, The risks and benefits of clozapine versus chlorpromazine, Prevalence and severity of akathisia in patients on clozapine, The prevalence of acute extrapyramidal signs and symptoms in patients treated with clozapine, risperidone, and conventional antipsychotics, Placebo-level incidence of extrapyramidal symptoms (EPS) with quetiapine in controlled studies of patients with bipolar mania, Olanzapine versus chlorpromazine in the treatment of schizophrenia: a pooled analysis of four 6-week, randomized, open-label studies in the Middle East and North Africa, Olanzapine monotherapy and olanzapine combination therapy in the treatment of mania: 12-week results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) observational study, Akathisia and second-generation antipsychotic drugs, Administration of metoclopramide by infusion or bolus does not affect the incidence of drug-induced akathisia, Slower infusion of metoclopramide decreases the rate of akathisia, Acute dystonia and akathisia following droperidol administration misdiagnosed as psychiatric disorders, Antidepressant-induced akathisia-related homicides associated with diminishing mutations in metabolizing genes of the CYP450 family, A Case of severe akathisia with atomoxetine, Venlafaxine-related akathisia side-effects and management in a depressed patient, A 40-week double-blind aripiprazole versus lithium follow-up of a 12-week acute phase study (total 52 weeks) in bipolar I disorder, Parkinsonism and other movement disorders in outpatients in chronic use of cinnarizine and flunarizine, Tetrabenazine as antichorea therapy in Huntington disease: a randomized controlled trial, The Effectiveness of intramuscular biperiden in acute akathisia, Immediate effect of intravenous diazepam in neuroleptic-induced acute akathisia: an open-label study, Trazodone for the treatment of neuroleptic-induced acute akathisia: a placebo-controlled, double-blind, crossover study, Midazolam vs. diphenhydramine for the treatment of metoclopramide-induced akathisia: a randomized controlled trial, Diphenhydramine in the treatment of akathisia induced by prochlorperazine, A randomized trial of diphenhydramine as prophylaxis against metoclopramide-induced akathisia in nauseated emergency department patients, A trial of midazolam vs diphenhydramine in prophylaxis of metoclopramide-induced akathisia, Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study, The 5-HT1D receptor agonist zolmitriptan for neuroleptic-induced akathisia: an open label preliminary study, Akathisia and acute dystonia induced by sumatriptan, A controlled trial of amantadine in drug-induced extrapyramidal disorders, Development of tolerance to the therapeutic effect of amantadine on akathisia, Treatment of neuroleptic-induced akathisia with nicotine patches, Opioid responsiveness in patients with neuroleptic-induced akathisia, Amitriptyline in the treatment of neuroleptic-induced akathisia, Severe acute dystonia/akathisia after paliperidone palmitate application – a case study, A placebo-controlled, double-blind study of the efficacy and safety of aripiprazole for the treatment of acute manic or mixed episodes in Asian patients with bipolar I disorder (the AMAZE study), The efficacy and safety of aripiprazole as adjunctive therapy in major depressive disorder: a multicenter, randomized, double-blind, placebo-controlled study, Double-blind comparison of ziprasidone and risperidone in the treatment of Chinese patients with acute exacerbation of schizophrenia, Persistent akathisia masquerading as agitated depression after use of ziprasidone in the treatment of bipolar depression, Delayed-onset akathisia due to amisulpride, Amisulpride versus risperidone treatment for behavioral and psychological symptoms in patients with dementia of the Alzheimer type: a randomized, open, prospective study, Lurasidone for the treatment of acutely psychotic patients with schizophrenia: a 6-week, randomized, placebo-controlled study, Efficacy and safety of lurasidone 80 mg/day and 160 mg/day in the treatment of schizophrenia: a randomized, double-blind, placebo- and active-controlled trial, Safety profile of iloperidone in the treatment of schizophrenia, Cariprazine in schizophrenia: clinical efficacy, tolerability, and place in therapy, Akathisia and exacerbation of psychopathology: a preliminary report, Intravenous biperiden in akathisia: an open pilot study, A case of respiratory akathisia in a cancer patient: a case report, A double-blind comparison of clonazepam and placebo in the treatment of neuroleptic-induced akathisia, Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study, Cyproheptadine treatment in neuroleptic-induced akathisia, Treatment of neuroleptic induced akathisia with the 5-HT2 antagonist ritanserin, Treatment of neuroleptic-induced akathisia with the 5-HT2 antagonist mianserin.