Akathisia refers to an urge to keep moving. Typically
the patients will pace about in the house and sit down and get up
again. First line treatment of akathisia is propranolol although
benzodiazepines have also been used. Akathisia can occur any time after starting the medication.
Tardive duskinesia (TD) refers to
involuntary movements which can be perioral (such as lip smaking,
chewing and darting tongue movements) or choreoathetoid movements of
extremities or other body parts. TD usually does not occur within the
first 3 months of starting the medications. TD can be difficult to
treat and may require changing to medications that do no cause this
side effect such as clozapine.
Dystonia occur within
hours or days of starting the therapy. Characteristic features
include muscle spasms (e.g. torticollis). Treatment of dystonia is
acomplished by antihistaminic medications like diphenhydramine
(Benadryl) or anticholinergics like benztropine or trihexphenidyl.
Neurolept maligant syndrome is a known
side of antipsychotics that presents with hyperthermia, muscle rigidity
and mental status changes. It usually occurs after 1-2 weeks of
starting the therapy. Treatment includes stopping the medication and
use of dantrolene, bromocriptine and amantidine.
Commonest antipsychotics leading to these side effects inlcude: chlorpromazine (Thorazine, Largactil), Fluphenazine (Prolixin) - Available in decanoate (long-acting) form, Perphenazine (Trilafon), Prochlorperazine (Compazine), Thioridazine (Mellaril, Melleril), Trifluoperazine (Stelazine), Mesoridazine, Periciazine, Promazine, Triflupromazine (Vesprin), Levomepromazine (Nozinan), Promethazine (Phenergan), Pimozide (Orap), Chlorprothixene (Cloxan, Taractan, Truxal), Clopenthixol (Sordinol), Flupenthixol (Depixol, Fluanxol), Thiothixene (Navane), Zuclopenthixol (Cisordinol, Clopixol, Acuphase)
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