Central action beta-blockers versus placebo for neuroleptic-induced acute akathisia

Abstract

Central action beta-blockers versus placebo for neuroleptic-induced acute akathisia.

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

“…There are also data supporting the utility of clonidine, a selective alpha-2 adrenergic agonist, in medication-related akathisia when other strategies fail [ 68 ]. Conversely, results from meta-analyses such as the Cochrane Review have reported that the efficacy of BB as well as anticholinergic agents in the treatment of akathisia is poor at best [ 73 , 74 ].…”

Movement Disorders Associated With Antipsychotic Medication in People With Schizophrenia: An Overview of Cochrane Reviews and Meta-Analysis

“…The relative motor toxicity observed in our analysis may reflect both different antagonistic potency on the serotonergic 5-HT 2A receptor, 51,52 and different association kinetics for the dopamine D 2 R receptor. 4,53 Higher 5-HT 2A antagonism may have a balancing effect on striatal dopamine signaling, eventually protecting from motor side effects. 54 Although our prevalence estimates parallel to a certain degree this pharmacodynamic property, an important exception is amisulpride, which has relatively high D 2 R selectivity and lower 5-HT 2 A antagonistic potential 55 but yielded a movement disorder prevalence that was substantially lower than the FGAs.…”

“…Unlike our report, though, Leucht et al measured 'extrapyramidal side effects' as a whole and adopted 'use of antiparkinson drugs' as a surrogate measure of movement disorders. This approach provided odds ratios that most likely reflect only the occurrence of parkinsonism, dystonia and possibly tremor, whereas an important motor side effect like akathisia, which differs from other movement disorders with respect to pharmacological management, 1,4 might have been under-ascertained. We also acknowledge that, in our study, the rescue or prophylactic use of anticholinergic drugs in older clinical trials of FGAs, such as haloperidol, may have led to an underestimation of the prevalence of movement disorders for this agent.…”

“…3 The modulation of acute dystonia or akathisia by anticholinergics or b-adrenergic antagonists suggests, however, the involvement also of other neurotransmitters in these movement disorders. 3,4 Drug-induced parkinsonism overlaps substantially with Parkinson's disease, although the former diagnosis is supported by a highly symmetrical presentation, 1 a lack of gait and balance difficulties, 5 a negative dopamine transporter single-photon emission computed tomography scan, 6 and attenuation with dose reduction or discontinuation of the antipsychotic medication. Tardive involuntary movements (choreiform dyskinesia, dystonia, akathisia, and less commonly myoclonus, tourettism and tremor) are also associated with maladaptive plastic rearrangements of the inferior frontal cortex, which is highly connected to deep subcortical nuclei and in the modulation of motor output selection.…”

Prevención y tratamiento de los efectos adversos agudos más frecuentes por el uso de antipsicóticos en pacientes adultos con diagnóstico de esquizofrenia

“…Una de las medidas terapéuticas propuestas para su manejo es el uso de betabloqueadores de acción central bajo la hipótesis de que estos antagonizan los efectos inhibitorios en el área tegmental ventral, que es el origen de las vías mesolímbica y mesocortical, lo que mejoraría la transmisión dopaminérgica. Un metaanálisis buscó evaluar la efectividad clínica de los betabloqueadores de acción central para el manejo de la acatisia inducida por neurolépticos 15 .…”