Treatment of Antipsychotic-Induced Akathisia: Role of Serotonin 5-HT2a Receptor Antagonists

  title={Treatment of Antipsychotic-Induced Akathisia: Role of Serotonin 5-HT2a Receptor Antagonists},
  author={Michael Poyurovsky and Abraham Weizman},
  pages={871 - 882}
Akathisia is one of the most prevalent and distressing adverse effects associated with antipsychotic drug treatment. Propranolol, a non-selective beta-adrenergic receptor antagonist, is currently considered a first-line treatment for antipsychotic-induced akathisia (AIA). Surprisingly, the evidence for its anti-akathisia effect is modest. Propranolol’s side effects (e.g. orthostatic hypotension, bradycardia), contraindications (e.g. asthma) and increased complexity in titration schedules limit… 

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

Patients should first receive an adjustment in their antipsychotic drug regimen, and if further intervention is needed, propranolol is considered as the first-choice anti-akathisia agent.

Drug–drug interactions involving antipsychotics and antihypertensives

The current knowledge is sufficiently strong to guide clinicians in selecting safer drug combinations as summarized here to provide the clinician an insight into the pharmacokinetic and pharmacodynamic interactions between these drugs.

Akathisia and atypical antipsychotics. Relation to suicidality, agitation and depression in a clinical trial.

Akathisia is still a prevalent side effect in a clinically relevant sample of patients treated with atypical antipsychotics, and the results suggest that akath is significantly associated with depression, suicidality, and agitation in different subgroups of patients receiving antipsychotic drugs.

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  • 2021
The pharmacological target profile features of frequently used antipsychotic agents, in relation to estimated free plasma exposure levels at clinically efficacious dosing, are described and discussed from the rational pharmacodynamic and pharmacokinetic pros and cons point ofview.

Case of aripiprazole long‐acting‐related akathisia successfully managed with carvedilol: A case report

The author has not received research support or speakers’ honoraria from, or has served as a consultant to, Sumitomo Dainippon, Otsuka, DAIICHI SANKYO, Tsuruma, Nihon Medi-Physics and Pfizer.

Use of Zebrafish Models to Boost Research in Rare Genetic Diseases

The unique advantages of zebrafish models over other in vivo models are emphasized, particularly underlining the high throughput phenotypic capacity for therapeutic screening and the use to identify innovative therapeutic solutions.

Akathisia after chronic usage of synthetic cathinones: A case study

The current case suggests that besides cocaine, amphetamines and methamphetamines, synthetic cathinones can also increase the risk for development of extrapyramidal symptoms such as akathisia.



Treatment of Neuroleptic-Induced Akathisia With the 5-HT2A Antagonist Trazodone

Trazodone is found to be a beneficial and relatively safe medication for the treatment of antipsychotic medication-induced akathisia and some improvement was noted in symptomatology of anxiety, depression, and psychosis.

Lack of efficacy of the 5-HT3 receptor antagonist granisetron in the treatment of acute neuroleptic-induced akathisia.

It seems that the 5-HT3 subtype of serotonergic receptor is not involved in the development of NIA, and 5- HT3 antagonists are ineffective in the serotonin-related pharmacotherapy of Nia.

Trazodone for the Treatment of Neuroleptic-Induced Acute Akathisia: A Placebo-Controlled, Double-Blind, Crossover Study

It is suggested that Trz's property of serotonin 2A postsynaptic receptor antagonism may be its principal mechanism for the improvement of NIA.

Treatment of neuroleptic induced akathisia with the 5-HT2 antagonist ritanserin.

First results of a single-blind trial of ritanserin in the treatment of neuroleptic-induced akathisia are encouraging and warrant further studies.

SSRI-Induced extrapyramidal side-effects and akathisia: implications for treatment

  • R. Lane
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    Journal of psychopharmacology
  • 1998
It is important that the rare occurrence of EPS in patients receiving SSRIs does not preclude their use in Parkinson's disease where their potentially significant role requires more systematic evaluation.

5-HT2A receptor antagonists for the treatment of neuroleptic-induced akathisia: a systematic review and meta-analysis.

The findings suggest that 5-HT(2A) antagonists are effective in the treatment of NIA and should be considered as a first-line treatment for neuroleptic-induced akathisia.

Serotonergic agents in the treatment of acute neuroleptic‐induced akathisia: open‐label study of buspirone and mianserin

It seems that the 5-HT1A partial agonist buspirone is of limited value in the treatment of acute neuroleptic-induced akathisia, and in contrast, it appears that low-dose mianserin is therapentically effective in acute neuroLEptic- induced akath isia.

Treatment of neuroleptic-induced akathisia with the 5-HT2 antagonist mianserin

Mianserin at a low dose may be a promising therapeutic option for patients with acute neuroleptic-induced akathisia, as well as by other relevant clinical rating scales.

Medication-Induced Akathisia with Newly Approved Antipsychotics in Patients with a Severe Mental Illness: A Systematic Review and Meta-Analysis

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