• Akathisia is an adverse effect sometimes associated with the administration of medications such as neuroleptic anti-psychotics (i.e. chlorpromazine (Thorazine); haloperidol (Haldol); ziprazidone (Geodon)) and dopamine-blocking anti-emetics (i.e. metoclopramide (Reglan); prochlorperazine (Compazine)).

• This unpleasant symptom complex consists of restlessness and agitation, the severity of which correlates with the dose of the causative agent.

• Treatment classically consists of stopping or decreasing the dose of the causative agent and administering diphenhydramine (Benadryl).

• Benzodiazepines, beta blockers, and the antihistamine cyproheptadine have also been used with success.

• The following instrument, a modified version of the Prince Henry Hospital Scale of Akathisia, can be used to clinically assess for akathisia in a standardized fashion:

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Subjective Findings Do you feel restless or the urge to move especially in th legs? 0=No (none)     1=Some times (mild)    2=Most times (mod)    3=All times (severe) Objective Findings Observe patient for 2 full minutes on stopwatch: For how much time were they off their stretcher? 0=None   1=1 to 30 sec.     2=31 to 60 secs.     3=61 to 108 secs.    4=Whole time For how much time do they have purposeless or semi-purposeless leg or foot movement? 0=None   1=1 to 30 sec.     2=31 to 60 secs.     3=61 to 108 secs.    4=Whole time Diagnosis requires an elevation of 1 grade or more in the reported severity of subjective findings between the baseline and follow-up assessment (i.e. from none to mild, mild to mod.), with objective corroboration.

 

References

• Friedman, et al. "A Randomized Trial of Diphenhydramine as Prophylaxis Against Metoclopramide-Induced Akathisia in Nauseated Emergency Department Patients."  Annals of Emergency Medicine, 53(3): March 2009.