Drug-Induced Acute Akathisia (Restlessness)

The drug-induced disease acute akathisia (restlessness) could be mistaken for anxiety or agitation related to mental health disorders, according to a review of the disease published in the December 2010 issue of Australian Prescriber.

Such mistakes can result in changes to drug treatment, particularly for those taking antipsychotics, that might worsen the akathisia.

Acute drug-induced akathisia is most commonly seen in patients taking typical or atypical antipsychotic drugs and antidepressants but can also occur with antiemetics, calcium channel blockers, and other medicines. Patients experiencing drug-induced akathisia have feelings of “inner” restlessness and the drive to move, which can result in significant distress. The symptoms of drug-induced akathisia may include the following:

• fidgety movements
• leg swinging while sitting
• rocking from foot to foot or pacing
• motor restlessness, characterized by muscular quivering and the inability to sit still

The combination of akathisia, depressive symptoms and impulsiveness also may contribute to aggressiveness and suicidality in some patients with the disorder.

An analysis of a large clinical trial published in the British Journal of Psychiatry in 2008 estimated that 26 percent to 35 percent of people taking atypical antipsychotic drugs experienced akathisia each year, compared with 35 percent taking the older typical antipsychotic perphenazine.

How to find out if your drug causes akathisia or other side effects

Drugs that contain warnings about akathisia in their Food and Drug Administration (FDA)-approved professional product labels, or package inserts, are listed in Table 1.

Although the drugs listed in the tables are more likely to cause akithisia, other drugs may also cause this problem. You can find out if your drug causes akathisia or another side effect by using the National Library of Medicine’s DailyMed database at http://dailymed.nlm.nih.gov/dailymed/about.cfm. DailyMed contains the professional product labels for more than 20,800 drugs.

To find out if your drug causes a specific side effect or adverse reaction:

1. Go to the DailyMed database.
2. Enter the brand or generic name of the drug you are interested in.
3. You will then see a list of specific products, including different dosage forms (e.g., tablets, capsules) of your drug. Click on the one that you are interested in, and then click “go” and you will see a full electronic copy of the package insert that is updated in real time.
4. For example, if you are using Internet Explorer, click on the Edit function. This will give you the option to “Find on This Page.” In the search box that appears, enter the side effect you want to check. Then click on “Next” and the computer will search for the term you entered, such as akathisia. Other browsers have similar capabilities. You may have to enter the medical term instead of a common term when searching for a side effect (e.g., you would have to enter akathisia rather than restlessness).

What You Can Do

You should contact your health care professional immediately if you develop the symptoms listed in this article that are associated with akathisia.

Consumers may report serious adverse events with products to the FDA’s MedWatch Adverse Event Reporting program either online or by regular mail, fax or phone.

• Online: https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm
• Regular mail: Use postage-paid, pre-addressed FDA form 3500 and mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787
• Fax: (800) FDA-0178
• Phone: (800) FDA-1088

Table 1. Drugs That May Cause Akathisia

*Do Not Use
**Limited Use
***Do Not Use Until Seven Years After Approval
****Last Choice