netsavy006 Posted October 13, 2010 Share Posted October 13, 2010 I just realized from old posts from doing a search about which anti-akathisia medications I cannot take: Cogentin - didn't work (nothing positive or negative; even when taken with 5mg TID of Valium) - was on 1mg BID Artane - causes itchiness which causes me to scratch potentially causing me to bleed - was on 2mg TID Benadryl - causes a paradoxical excitability reaction instead of a calming reaction. - attempted 25mg every 4 hours, then 50mg every 4 hours Inderal (propranolol) - caused "brain zaps" between doses (was on 10mg BID and 20mg BID) Other than Symmetrel (Amantadine), what's left, considering I'm already taking a benzodiazapine (Ativan (lorazapam) 1mg QID) Thanks, Andy. Link to comment Share on other sites More sharing options...
etkearne Posted November 21, 2010 Share Posted November 21, 2010 Any number of Dopamine (especially D2) agonists could be used. Check out Dopamine agonist on wikipedia or a similar site. Link to comment Share on other sites More sharing options...
SashaSue Posted November 22, 2010 Share Posted November 22, 2010 Andy, are you actually experiencing akathesia, or is this more of a theoretical inquiry? ETKEarne, while that is theoretically correct, agonizing dopamine willy nilly in someone with either a mood or a psychotic disorder could be destabilizing, and end up doing more harm than good. Link to comment Share on other sites More sharing options...
netsavy006 Posted November 22, 2010 Author Share Posted November 22, 2010 At the time of the post I was experiencing akathisia because I was on multiple antipsychotics, one of which was causing the problem and I didn't know what options I had. Since the OP, the offending medication has been removed and I'm no longer having the problem. I'm no longer going to be taking any other antipsychotic other than Clozaril from now on by agreement between me and my pdoc. Thanks, Andy. Link to comment Share on other sites More sharing options...
wondernut Posted November 22, 2010 Share Posted November 22, 2010 it is an old post for Andy Link to comment Share on other sites More sharing options...
SashaSue Posted November 22, 2010 Share Posted November 22, 2010 Ah, right. Sorry, I missed that. Link to comment Share on other sites More sharing options...
etkearne Posted November 23, 2010 Share Posted November 23, 2010 Andy, are you actually experiencing akathesia, or is this more of a theoretical inquiry? ETKEarne, while that is theoretically correct, agonizing dopamine willy nilly in someone with either a mood or a psychotic disorder could be destabilizing, and end up doing more harm than good. I'm just saying...it has been used. It is not unheard of. Dangerous, maybe. Unheard of, no. Link to comment Share on other sites More sharing options...
AnneMarie Posted November 23, 2010 Share Posted November 23, 2010 Andy, are you actually experiencing akathesia, or is this more of a theoretical inquiry? ETKEarne, while that is theoretically correct, agonizing dopamine willy nilly in someone with either a mood or a psychotic disorder could be destabilizing, and end up doing more harm than good. I'm just saying...it has been used. It is not unheard of. Dangerous, maybe. Unheard of, no. Maybe if there serious risks, you could mention as much. Link to comment Share on other sites More sharing options...
Velvet Elvis Posted November 23, 2010 Share Posted November 23, 2010 It's really not that uncommon to use with someone who is stable. You can develop a tolerance to H-1 blockers after a while. If the person has been stable and doing well on whatever AP they are on when the H-1 blocker poops out, dopamine agonists are usually worth the risk since the person has a fair chance of relapse if the AP is changed anyway. Link to comment Share on other sites More sharing options...
AnneMarie Posted November 23, 2010 Share Posted November 23, 2010 What drugs are you talking about? I haven't heard of Mirapex or Requip being prescribed for akathesia. Link to comment Share on other sites More sharing options...
SashaSue Posted November 23, 2010 Share Posted November 23, 2010 It's really not that uncommon to use with someone who is stable. You can develop a tolerance to H-1 blockers after a while. If the person has been stable and doing well on whatever AP they are on when the H-1 blocker poops out, dopamine agonists are usually worth the risk since the person has a fair chance of relapse if the AP is changed anyway. With someone who is stable. So there's that. But H-1 blockers themselves are really only kind of stopgap measures for most people. Though I'm sure someone's out there, I can't think of anyone around here who's taken benadryl as a long term treatment of akathisia. In any case, it's efficacy isn't about the h-1 blockade, it's about the anticholinergic effects. First line treatment for akathisia = anticholinerergics. Then there are beta blockers and benzos. There's really enough stuff to try that, even for a stable person, dopaminergic meds are really a last resort. Partly because of the risk of instability, but also because they don't seem to be all that effective. Link to comment Share on other sites More sharing options...
AnneMarie Posted November 23, 2010 Share Posted November 23, 2010 Serotonin-based pharmacotherapy for acute neuroleptic-induced akathisia: a new approach to an old problem A little dated but interesting. The results of clinical trials with serotonergic agents in thetreatment of acute NIA are summarised in Table 2. Althoughthere are no selective 5-HT2a antagonists available for clinicaluse, three compounds with pronounced 5-HT2a antagonistic activity,ritanserin, cyproheptadine and mianserin, have been suggestedas anti-akathisia remedies. Link to comment Share on other sites More sharing options...
Velvet Elvis Posted November 23, 2010 Share Posted November 23, 2010 What drugs are you talking about? I haven't heard of Mirapex or Requip being prescribed for akathesia. Mostly older stuff used for Parkinson's. I can look it up in the AM. I think it was in Stahl, if not in some other psychopharmocology book I pirated. Link to comment Share on other sites More sharing options...
etkearne Posted November 23, 2010 Share Posted November 23, 2010 Isn't Dicyclomine a powerful anticholinergic? It is ususallly used for gastro-intestinal problems, but I could understand it "theoretically" working here. And it is pretty safe. My mom takes it for Ulcerative Colitis every day. Link to comment Share on other sites More sharing options...
Aurochs Posted November 23, 2010 Share Posted November 23, 2010 Anticholinergics are the most common treatment for AP-induced akathisia. Diphenhydramine treats akathisia because it's an anticholinergic drug. It has nothing to do with H1 antagonism. Dopamine agonists also work, but as Sasha and Stacia noted, they're extremely risky for pyschiatric patients. I haven't heard much about dopamine agonists in psychiatric practice (which should say something in itself), but I'd be suprised if they were anything other than a fourth- or fifth-line treatment. Link to comment Share on other sites More sharing options...
SashaSue Posted November 23, 2010 Share Posted November 23, 2010 Serotonin-based pharmacotherapy for acute neuroleptic-induced akathisia: a new approach to an old problem A little dated but interesting. The results of clinical trials with serotonergic agents in thetreatment of acute NIA are summarised in Table 2. Althoughthere are no selective 5-HT2a antagonists available for clinicaluse, three compounds with pronounced 5-HT2a antagonistic activity,ritanserin, cyproheptadine and mianserin, have been suggestedas anti-akathisia remedies. Actually, there are several recent studies demonstrating the efficacy of of things like low dose mirtazipine, and trazadone, in treating akathisia. Link to comment Share on other sites More sharing options...
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