extrapyramidal reactions such as oculogyric crisis, dystonic reactions, akathisia

see also:

• parkinsonism

• acute extrapyramidal reactions are quite common neurologic reactions in some patients who take medications which block dopamine D2 receptors
• they are often sufficiently disturbing for the patient that they seek urgent medical attention
• common acute reactions include:
  • oculogyric crisis
  • acute dystonic reaction
  • akathisia
• these medications if taken for a sufficiently long period in susceptible patients may also cause an irreversible disabling movement disorder of the face called tardive dyskinesia
• medications which block dopamine D2 receptors include:
  • anti-emetics such as metoclopramide (Maxolon)
  • phenothiazines including prochlorperazine (Stemetil) and chlorpromazine (Largactil)
  • butyrophenone type antipsychotic agents including haloperidol and droperidol (Droleptan)
  • other antipsychotics such as olanzapine, risperidone, quetiapine
• other medications at risk:
  • SSRI/SNRI antidepressants
  • erythromycin
  • carbamazepine
• risk factors:
  • age < 30 yrs
  • male
  • PH or FH of dystonic reactions
  • recent cocaine or alcohol use
  • Rx with a potent dopamine D2 receptor antagonist (e.g. haloperidol)

• benztropine / benzatropine (Cogentin) im or iv