One of the adverse effects is akathisia. In the management of the fungal infections and malaria, the prescriber’s discretion in stopping the antipsychotic and/or antidepressants or reducing the dose(s) may be required in view of the elimination rates of the medications and their potential for drug-drug interactions. This tool can also be used to track your progress during treatment.. If you suspect akathisia, it’s important to see your doctor to get an official diagnosis. Fluoxetine 20 mg capsule was added to her treatment to be taken daily for the management of her complaints of persistent obsessive thoughts. Case B’s presenting complaints were restlessness, tremor, abdominal discomfort, constipation, and weight gain. While your prescribing doctor should have your medication history, they may not have it in a compact form. Fluoxetine and risperidone synergistically can also increase the QTc interval. Your doctor may also fill out the Barnes Akathisia-Rating Scale to assess the severity of your symptoms. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Ciprofloxacin also increases the plasma levels of olanzapine by inhibiting its metabolism by CYP1A2 [13]. This report presents two cases of drug-drug-induced akathisia. Her medications were reviewed; risperidone 2 mg tablet daily was switched to haloperidol 5 mg tablet daily and benzhexol 5 mg tablet daily. If you're feeling alone or frustrated about your symptoms, it can also help to confide in a trusted friend or family member. The patient had no other significant medical history or substance use history and did not consume alcohol or herbal preparations. However, modifying your mediation may also cause symptoms to worsen, or cause withdrawal akathisia. some can cause higher levels of the hormone prolactin. Schizophrenia medications are typically antipsychotic medications.These drug treatments for schizophrenia are specifically used to treat the positive symptoms associated with psychosis, such as hallucinations and delusions.Schizophrenia medication is normally prescribed by a psychiatrist and might be taken orally or by long-acting injection. The association between Case B’s presenting complaints and the administration of high-dose antipsychotics has been reported in literature [4]. Other medications known to cause akathisia include: Unfortunately, just as starting antipsychotic medication may cause akathisia, it is also observed in people who are being gradually taken off their antipsychotic medication, or who may be advised to gradually decrease their dosages. The purpose is to raise awareness of other possible causes of extrapyramidal side effects presented by patients on psychotropic medications. 5th ed. Potential Side Effects of Taking Seroquel for Mental Illness, Daily Tips for a Healthy Mind to Your Inbox, Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline, Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. The patient presented for review on day 14 with no improvement in her initial presenting complaints. Dealing with racing thoughts? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Some may also exhibit impulsive behavior and/or have suicidal ideation [7]. Patients stabilized on these medications who present with distressing complaints akin to akathisia may be triggered by other factors. Your body may feel anxious at the thought of sitting down. Testing a narrow version of the self-medication hypothesis, Relationship of neuroleptic-induced akathisia to drug-induced parkinsonism, Serum iron and ferritin in acute neuroleptic akathisia, Is there a rationale for iron supplementation in the treatment of akathisia? Curr Neuropharmacol. In one case report, ciprofloxacin was linked to a probable cause of akathisia in a woman who had taken ciprofloxacin one month earlier for sinusitis prior to presentation of severe akathisia [12]. Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges. The latter two medications were prescribed to treat a urinary tract infection. It occurs, in most instances, within four weeks of initiating antipsychotic therapy [6]. We are committed to sharing findings related to COVID-19 as quickly as possible. She presented 7 days later to her psychiatrist with complaints of restlessness, tremor, palpitations, insomnia, and resurgence of obsessive thoughts. (8) Was the reaction more severe when the dose was increased or less severe when the dose was decreased? J Psychopharmacol (Oxford). Thank you, {{form.email}}, for signing up. The prevalence of missed diagnosis is a dangerous problem as it can lead to negative outcomes such as missed medication dosages, which may exacerbate the psychiatric symptoms the drugs are meant to help manage. There were no abnormal laboratory findings. Disease states that commonly cause akathisia are renal impairment, diabetes mellitus, hyperthyroidism, iron deficiency anaemia, Parkinson’s disease, and peripheral neuropathy [8]. Case B was a 17-year-old African female admitted and managed for first-episode depression with psychotic symptoms. These complaints were distressing enough to account for her medication nonadherence. Forcen F. Akathisia: Is restlessness a primary condition or an adverse drug effect? It is important to conduct an in-depth medication review before a patient is discharged home after hospital admission and at each review. Furthermore, all the 4 medicines mentioned above can cause akathisia on their own. The obsessive thoughts used to be one of her complaints before being managed and stabilized on risperidone 2 mg tablet daily, and therefore, the obsessive thoughts could be a symptom of a relapse. Akathisia is diagnosed using an assessment tool like the Barnes akathisia rating scale (BARS). Non-adherence to medication is more common in any chronic illness, though rates of non-adherence are higher in schizophrenia than other chronic illnesses. Also, artemether/lumefantrine can increase the level or effect of risperidone by affecting its hepatic enzyme CYP2D6 metabolism. Block, MD, How the Atypical Antipsychotic Lurasidone Is Prescribed, Common and Serious Side Effects of Trilafon (Perphenazine), Side Effects of Thorazine for Bipolar Disorder. Also, ciprofloxacin and fluoxetine have akathisia listed as one of their side effects [12–14]. Double-blind, placebo-controlled study, Vitamin B6 versus mianserin and placebo in acute neuroleptic-induced akathisia: a randomized, double-blind, controlled study, Efficacy of low-dose mirtazapine in neuroleptic-induced akathisia: a double-blind randomized placebo-controlled pilot study, Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. In patients with mental disorders, a second-generation cephalosporin such as cefuroxime may be considered for the management of the urinary tract infection [18] instead of ciprofloxacin. The akathisia was managed by reducing her olanzapine 10 mg tablet to 5 mg daily and adding benzhexol 5 mg tablet daily (to be taken when needed) to her treatment regimen.