However, it can also be a symptom of akathisia. Subjective symptoms include restlessness, inner tension, anxiety, panic, irritability, discomfort, and sleeplessness [5, 7]. 2018;63(11):719-729. doi:10.1177/0706743718760288, Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. This may result in palpitations and arrhythmias . Some believe it is caused by a chemical imbalance triggered by the medication. Close this message to accept cookies or find out how to manage your cookie settings. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Curr Neuropharmacol. If you've been diagnosed with akathisia, your doctor may decrease your dosage or discontinue the medication causing your symptoms. (5) Are there alternative causes (other than the drug) that could on their own have caused the reaction? Commonly, extrapyramidal side effects caused by antipsychotics respond to these management measures and patients are observed to be improving with each passing day. It is one of the most common side effects of antipsychotic medications; between 15% and 45% of people who take antipsychotic medications experience akathisia. The latter two medications were prescribed to treat a urinary tract infection. A randomized, double-blind, placebo- and propranolol-controlled trial, Neurobehavioral mechanisms of impulsivity: fronto-striatal systems and functional neurochemistry, Use of atypical antipsychotic drugs in old age psychiatry, Atypical antipsychotics and movement disorders, Akathisia: Problem of History or Concern of Today, Antipsychotic-induced akathisia in delirium: A systematic review, Implications of the CATIE Trial on Treatment: Extrapyramidal Symptoms. The patient was discharged 10 days after admission. It is commonly associated with, but not limited to, the use of antipsychotics [3–5]. Medication-Induced Movement Disorders ... Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: a systematic review. Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. Physical and mental state examinations ruled out catatonia. Current Psychiatry. The incidence of akathisia in the treatment of schizophrenia with aripiprazole, asenapine and lurasidone: A meta-analysis. In patients with mental disorders, a second-generation cephalosporin such as cefuroxime may be considered for the management of the urinary tract infection  instead of ciprofloxacin. She also had no history of iron deficiency anaemia, diabetes mellitus, or renal failure that could predispose her to restless leg syndrome. One such underlying cause could be an adverse drug-drug interaction between antipsychotics, antidepressants, and antimicrobials. Nevertheless, her low Hb (9.5 g/dl) is a risk factor for akathisia and may have contributed to her developing it. Akathisia is generally underdiagnosed or misdiagnosed. However, modifying your mediation may also cause symptoms to worsen, or cause withdrawal akathisia. Her antipsychotic medication was switched from olanzapine 5 mg tablet daily to risperidone 2 mg tablet daily. A decision was taken to increase the dose of the haloperidol tablet prescribed from 2.5 mg daily to 5 mg daily. On day 31, she reported for review with complaints of restlessness and frequent urges to pace around. Your doctor may also fill out the Barnes Akathisia-Rating Scale to assess the severity of your symptoms. Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. Unfortunately, it is often not recognized or misdiagnosed. Also, ciprofloxacin and fluoxetine have akathisia listed as one of their side effects [12–14]. It occurs, in most instances, within four weeks of initiating antipsychotic therapy . When akathisia is induced by drugs, it is known as antipsychotic-induced acute akathisia (AIAA). 2017;15(5):789–798. It is one of the most common side effects of antipsychotic medications; between 15% and 45% of people who take antipsychotic medications experience akathisia. However, it may be hard to describe by patients and thus hard to diagnose by doctors. Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 5th ed. There is an increased probability of adverse drug-drug interactions when managing comorbid conditions. She did not drink alcohol or use herbal preparations and had no history of substance abuse. He specializes in pulmonary health, critical care, and sleep medicine. 2018. The association between Case B’s presenting complaints and the administration of high-dose antipsychotics has been reported in literature . Anticholinergics may also be considered if a patient shows signs of Parkinsonism . Also, artemether/lumefantrine can increase the level or effect of risperidone by affecting its hepatic enzyme CYP2D6 metabolism. Case A is a patient with schizophrenia who was being managed with risperidone 2 mg tablet daily for the past 3 years. (8) Was the reaction more severe when the dose was increased or less severe when the dose was decreased? The patient was also hypertensive and managed uneventfully on amlodipine 10 mg tablet daily, bendroflumethiazide 2.5 mg tablet daily, and atenolol 50 mg tablet daily. Dealing with racing thoughts? Her symptoms of akathisia are consistent with the adverse effects likely to be experienced from a drug-drug interaction between ciprofloxacin, risperidone, fluoxetine, and artemether/lumefantrine. J Psychopharmacol (Oxford). (1) Are there previous conclusive reports on this reaction? Review articles are excluded from this waiver policy. 2015;13(5):681-91. doi:10.2174/1570159X13666150115220221, Pringsheim T, Gardner D, Addington D, et al. It is recommended that the combination of fluoxetine and fluphenazine be avoided as the former inhibits the metabolism of the latter by liver enzyme CYP2D6. Extrapyramidal side effects of psychotropic medicines are usually experienced by patients in the first few weeks of initiating therapy. Case B’s presenting complaints were restlessness, tremor, abdominal discomfort, constipation, and weight gain. 2020, Article ID 9649483, 5 pages, 2020. https://doi.org/10.1155/2020/9649483, 1Department of Psychiatry, Korle Bu Teaching Hospital, P. O. Her laboratory results on admission showed a reduction in Hb (9.5 g/dl) and a raised platelet count (). Block, MD, How the Atypical Antipsychotic Lurasidone Is Prescribed, Common and Serious Side Effects of Trilafon (Perphenazine), Side Effects of Thorazine for Bipolar Disorder. Forcen F. Akathisia: Is restlessness a primary condition or an adverse drug effect? On direct questioning by the pharmacist, the patient disclosed visiting a nearby clinic a week ago when she fell ill. This report presents two cases of drug-drug-induced akathisia. To diagnose akathisia, your doctor will likely perform a physical exam, which includes observing you sitting and standing for several minutes to watch for psychomotor agitation. Do your best to keep a detailed record of the medications you are taking, including the dosage and when you started taking them. Akathisia, also spelled acathisia, is a neuropsychiatric syndrome or movement disorder characterized by inner restlessness and the inability to sit or stand still for a reasonable period of time.. This report presents two cases of drug-drug-induced akathisia. P. W. Ament, J. G. Bertolino, and J. L. Liszewski, “Clinically significant drug interactions,”, R. M. Goldberg, J. Mabee, L. Chan, and S. Wong, “Drug-drug and drug-disease interactions in the ED: Analysis of a high-risk population,”, M. A. Sullivan and R. Wilbur, “Gabapentin pharmacotherapy for antipsychotic-induced akathisia: single-patient experiment and case report,”, D. Kern and A. Lang, “Acute akathisia,” in, N. Iqbal, T. Lambert, and P. Masand, “Akathisia: problem of history or concern of today,”, L. P. Koliscak and E. H. Makela, “Selective serotonin reuptake inhibitor-induced akathisia,”, H. M. Cheng, J. H. Park, and D. Hernstadt, “Akathisia: a life-threatening side effect of a common medication,”, T. R. E. Barnes, “A rating scale for drug-induced akathisia,”, C. A. Naranjo, U. Busto, E. M. Sellers et al., “A method for estimating the probability of adverse drug reactions,”, C. Imboden and M. Hatzinger, “Agomelatine-induced akathisia with concomitant duloxetine medication: a case report,”, R. M. Lane, “SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment,”, M. Jauss, J. Schröder, J. Pantel, S. Bachmann, I. Gerdsen, and C. Mundt, “Severe akathisia during olanzapine treatment of acute schizophrenia,”, S. K. Pandey, “Risperidone induced dystonic reaction and akathisia,”, H. L. Wang, Y. T. Xiang, Q. Y. Li et al., “The effect of artemether on psychotic symptoms and cognitive impairment in first-episode, antipsychotic drug-naive persons with schizophrenia seropositive to Toxoplasma gondii,”.
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