Successful propranolol therapy for neuroleptic-induced akathisia resistant to anticholinergic and benzodiazepine drugs

Neuroleptic-induced akathisia (NIA) is one of the most common side effects of antipsychotic drugs and may appear in up to 75% of patients treated with certain high-potency neuroleptic drugs, such as haloperidol. The syndrome is characterized by both observable motor signs of agitation and a subjective feeling of inner tension and restlessness. NIA may contribute to the deterioration of mental condition and may bring about poor compliance and failure of neuroleptic treatment. It may lead to suicide attempts and to psychiatric hospitalization. Therefore, NIA warrants the maximum effort aimed at eliminating it. Anticholinergic and benzodiazepine drugs have been only partially effective in eradicating this adverse effect. A low-dose β-adrenoreceptor blocking agent-propranolol (PPN)-seems promising in the treatment of NIA. We describe four cases of NIA that were resistant to trihexyphenidyl (THP) and diazepam (DZP) that were treated effectively with PPN.