extrapyramidal reactions such as oculogyric crisis, dystonic reactions, akathisia

introduction

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:
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)