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Akathisia and Newer Second-Generation Antipsychotic Drugs: A Review of Current Evidence.

Authors
  • Chow, Constance L1
  • Kadouh, Nour K2
  • Bostwick, Jolene R2
  • VandenBerg, Amy M3
  • 1 Prescription Drug Plan, University of Michigan, Ann Arbor, Michigan.
  • 2 College of Pharmacy, University of Michigan, Ann Arbor, Michigan.
  • 3 Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan.
Type
Published Article
Journal
Pharmacotherapy
Publication Date
Jun 01, 2020
Volume
40
Issue
6
Pages
565–574
Identifiers
DOI: 10.1002/phar.2404
PMID: 32342999
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Akathisia continues to present a significant challenge in clinical practice. As a class, so-called atypical, or second-generation, antipsychotics (SGAs) are the mainstay of treatment for schizophrenia and are commonly used to treat mood disorders. These medications have traditionally been distinguished from first-generation antipsychotics by their lowered risk of extrapyramidal side effects (EPS) such as dystonia, dyskinesia, akathisia, and pseudoparkinsonism. However, the occurrence of EPS, particularly akathisia, has been demonstrated to some degree in all commercially available SGAs. This review examines the incidence of akathisia in nine newer SGAs in patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD). We performed a search of PubMed, ClinicalTrials.gov, Cochrane Central Register, and Google Scholar, as well as manufacturer websites and product labeling for published and unpublished clinical trials, meta-analyses, and systematic reviews. Studies evaluating adult patients with schizophrenia, bipolar disorder, or MDD were eligible for inclusion. Data on treatment-emergent akathisia rates were gathered from each study, and potential dose-response relationships were explored. A total of 177 studies were included in this review, comprising 58,069 patients across 414 treatment arms. Compared with placebo with a composite 3.7% incidence of akathisia, individual SGAs produced akathisia at total composite rates ranging from 2.9-13.0% across the included studies. High doses of an SGA were generally associated with an increased risk of akathisia. Clinicians should consider the risk of akathisia when choosing a treatment option and monitor for akathisia in patients beginning therapy with an SGA or following a dose increase of the SGA. © 2020 Pharmacotherapy Publications, Inc.

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