JAMA Netw Open

Antipsychotic-induced akathisia: How do drug treatments stack up?

April 2, 2024

According to this network meta-analysis, mirtazapine, biperiden (not used in U.S. [NUS]), and vitamin B6 were associated with the greatest efficacy for antipsychotic-induced akathisia (AIA), with vitamin B6 exhibiting the best efficacy and tolerance profile. Effective alternatives with slightly less favorable efficacy and tolerance profiles include trazodone, mianserin (NUS), and propranolol.

For this systematic review and network meta-analysis, investigators assessed the global akathisia score of 10 drugs in 15 double-blind randomized trials with 492 participants. Primary outcome was severity of akathisia measured by a validated scale at the last available end point.

The following drugs were associated with greater efficacy than placebo (with low to moderate heterogeneity):

• mirtazapine (15 mg/day for ≥5 days; standard mean difference [SMD], −1.20; 95% confidence interval [CI], −1.83 to −0.58)
• biperiden (6 mg/day for ≥14 days; SMD, −1.01; 95% CI, −1.69 to −0.34)
• vitamin B6 (600-1200 mg/day for ≥5 days; SMD, −0.92; 95% CI, −1.57 to −0.26)
• trazodone (50 mg/day for ≥5 days; SMD, −0.84; 95% CI, −1.54 to −0.14)
• mianserin (15 mg/day for ≥5 days; SMD, −0.81; 95% CI, −1.44 to −0.19)
• propranolol (20 mg/day for ≥6 days; SMD, −0.78; 95% CI, −1.35 to −0.22)

Cyproheptadine, clonazepam, zolmitriptan, and valproate didn’t yield significant effects.

Sensitivity analyses generally confirmed the results for all drugs except cyproheptadine and propranolol. No association was found between effect sizes and psychotic severity.

Source:

Gerolymos C, et al. (2024, March 27). JAMA Netw Open. Drug Efficacy in the Treatment of Antipsychotic-Induced Akathisia: A Systematic Review and Network Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/38451521/