Akathisia

For advice on monitoring for and preventing antipsychotic adverse effects, see Overview of antipsychotic adverse effects.

Akathisia is an abnormal, uncomfortable sensation of restlessness and the urge to move.

To treat antipsychotic-induced akathisia, reduce the antipsychotic dose until the akathisia disappears, or if this is ineffective or not possible, switch to an antipsychotic less likely to cause extrapyramidal adverse effects—see Approximate relative frequency of common adverse effects of antipsychotics for approximate relative frequencies of extrapyramidal effects.

If a child develops akathisia, refer to their specialist (eg psychiatrist) for advice on management.

Only a small proportion of patients respond to symptomatic treatment of akathisia with a drug—reducing the dose of or switching the antipsychotic is preferable. If an adult has intolerable akathisia, while adjusting antipsychotic therapy, consider:

1 propranolol 10 to 20 mg orally, twice daily; if necessary, increase the dose up to 20 to 40 mg 3 or 4 times a day. Maximum daily dose 120 mg akathisia, antipsychotic adverse effect propranolol propranolol propranolol

OR

2 clonazepam 0.5 to 1.5 mg orally, up to twice daily for up to 2 weeks; slowly reduce dose over the last few days to stop akathisia, antipsychotic adverse effect clonazepam clonazepam clonazepam

OR

2 diazepam 2 to 5 mg orally, 3 times a day for up to 2 weeks; slowly reduce dose over the last few days to stop akathisia, antipsychotic adverse effect diazepam diazepam diazepam

OR

3 mirtazapine 15 mg orally, at night. akathisia, antipsychotic adverse effect mirtazapine mirtazapine mirtazapine