Manage antipsychotic-induced akathisia by making changes to the antipsychotic drug regimen and/or adding anti-akathisia agents

Abstract

Antipsychotic-induced akathisia (AIA) is a common and distressing adverse effect associated with many first- and second-generation antipsychotics. The risk of developing AIA can be minimized by administering the minimal effective dosage of an antipsychotic, avoiding rapid dose escalation and avoiding antipsychotic polypharmacy. Once AIA is diagnosed, patients should first receive an adjustment in their antipsychotic drug regimen (i.e. stop antipsychotic polypharmacy if applicable, lower the dosage of the antipsychotic medication or switch to an antipsychotic with lower AIA potential). If further intervention is needed, propranolol is considered as the first-choice anti-akathisia agent. Alternatively, low-dose mirtazapine, anticholinergics and benzodiazepines can also be considered.