Extrapyramidal reaction - Revision history

Danbot: Add MedicationDose entries for diphenhydramine, benztropine

2026-03-20T21:16:05Z

Add MedicationDose entries for diphenhydramine, benztropine

← Older revision		Revision as of 21:16, 20 March 2026
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	==Disposition==		==Disposition==

			==Medication Dosing==
			{{MedicationDose
			\| drug = Diphenhydramine
			\| dose = 25-50mg PO or IV
			\| route = PO/IV
			\| context = Anticholinergic for acute dystonia/akathisia
			\| indication = Extrapyramidal reaction
			\| population = Adult
			}}
			{{MedicationDose
			\| drug = Benztropine
			\| dose = 1-2mg PO or IV/IM
			\| route = PO/IV/IM
			\| context = Anticholinergic for acute dystonia/akathisia
			\| indication = Extrapyramidal reaction
			\| population = Adult
			}}

	==See Also==		==See Also==

Rossdonaldson1: /* Movement Disorders and Other Causes of Abnormal Muscle Contractions */

2020-11-14T13:37:12Z

Movement Disorders and Other Causes of Abnormal Muscle Contractions

@@ Line 22: / Line 22: @@
 ==Differential Diagnosis==
-===Movement Disorders and Other Causes of Abnormal Muscle Contractions===
+{{Movement disorder DDX}}
 ==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2020-11-14T13:36:16Z

Differential Diagnosis

@@ Line 22: / Line 22: @@
 ==Differential Diagnosis==
 *[[Neuroleptic malignant syndrome]]
 *[[Serotonin syndrome]]
@@ Line 31: / Line 32: @@
 *[[Phencyclidine toxicity]]
 *[[Anti-NMDA receptor encephalitis]]
 ==Evaluation==

ClaireLewis at 02:29, 3 October 2019

2019-10-03T02:29:29Z

← Older revision		Revision as of 02:29, 3 October 2019
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	**hours to days after drug initiation		**hours to days after drug initiation
	**reversible		**reversible
	**Acute [[~~Dystonic~~ reaction]]		**Acute [[dystonic reaction]]
	***involuntary, uncoordinated skelatal muscle contraction		***involuntary, uncoordinated skelatal muscle contraction
	**Akathisia		**Akathisia
Line 15:		Line 15:
	*Parkinsonism		*Parkinsonism
	**onset weeks to months after starting medication		**onset weeks to months after starting medication
	**similar presentation to [[Parkinson's disease]] (e.g. cogwheel ~~regidity~~, pill-rolling tremor, shuffling gait, bradykinesia)		**similar presentation to [[Parkinson's disease]] (e.g. cogwheel rigidity, pill-rolling tremor, shuffling gait, bradykinesia)
	*Tardive dyskinesia		*[[Tardive dyskinesia]]
	**usually irreversible or only partially reversible		**usually irreversible or only partially reversible
	**associated with prolonged use of antipsychotics		**associated with prolonged use of antipsychotics
	**~~sterotyped~~, repetitive facial movements (e.g. tongue protrusion, grimacing, lip smacking)		**stereotyped, repetitive facial movements (e.g. tongue protrusion, grimacing, lip smacking)

	==Differential Diagnosis==		==Differential Diagnosis==
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	*Stop or reduce offending agent		*Stop or reduce offending agent
	**may need to discuss with psychiatrist to prescribe new medication or for recs on taper		**may need to discuss with psychiatrist to prescribe new medication or for recs on taper
	*Acute dystonia, akasthisia, parkinsonism		*Acute [[dystonic reaction\|dystonia]], akasthisia, parkinsonism
	**[[diphenhydramine]] 25-50mg PO or IV		**[[diphenhydramine]] 25-50mg PO or IV
	**'''OR''' [[benztropine]] 1-2mg PO or IV/IM		**'''OR''' [[benztropine]] 1-2mg PO or IV/IM
	**continue PO antihistamines for 2 days after stopping antipsychotic		**continue PO antihistamines for 2 days after stopping antipsychotic
	**+/- [[benzodiazepines]]		**+/- [[benzodiazepines]]
	*Tardive dyskinesia		*[[Tardive dyskinesia]]
	**may only be partially reversible, so minimize occurrence, stop or reduce offending agent promptly		**may only be partially reversible, so minimize occurrence, stop or reduce offending agent promptly
	**Do NOT give anticholinergics, will exacerbate symptoms		**Do NOT give anticholinergics, will exacerbate symptoms

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T21:57:51Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 21:57, 30 May 2017
Line 39:		Line 39:
	*Acute dystonia, akasthisia, parkinsonism		*Acute dystonia, akasthisia, parkinsonism
	**[[diphenhydramine]] 25-50mg PO or IV		**[[diphenhydramine]] 25-50mg PO or IV
	**OR [[benztropine]] 1-2mg PO or IV/IM		**'''OR''' [[benztropine]] 1-2mg PO or IV/IM
	**continue PO antihistamines for 2 days after stopping antipsychotic		**continue PO antihistamines for 2 days after stopping antipsychotic
	**+/- [[benzodiazepines]]		**+/- [[benzodiazepines]]

ClaireLewis: /* Management */

2016-09-25T17:01:19Z

Management

← Older revision		Revision as of 17:01, 25 September 2016
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	*Acute dystonia, akasthisia, parkinsonism		*Acute dystonia, akasthisia, parkinsonism
	**[[diphenhydramine]] 25-50mg PO or IV		**[[diphenhydramine]] 25-50mg PO or IV
	**OR benztropine 1-2mg PO or IV/IM		**OR [[benztropine]] 1-2mg PO or IV/IM
	**continue PO antihistamines for 2 days after stopping antipsychotic		**continue PO antihistamines for 2 days after stopping antipsychotic
	**+/- [[benzodiazepines]]		**+/- [[benzodiazepines]]

ClaireLewis: Created page with "==Background== Adverse effect of antipsychotics. More common with high-potency typical antipsychotics, but can also occur with atypical agents *Due to antagonism of dopa..."

2016-09-22T19:17:35Z

Created page with "==Background== *Adverse effect of antipsychotics. *More common with high-potency typical antipsychotics, but can also occur with atypical agents *Due to antagonism of dopa..."

New page

==Background==
*Adverse effect of [[antipsychotics]].
*More common with high-potency typical antipsychotics, but can also occur with atypical agents
*Due to antagonism of dopamine-2 receptors in basal ganglia

==Clinical Features==
*Early-onset syndromes
**hours to days after drug initiation
**reversible
**Acute [[Dystonic reaction]]
***involuntary, uncoordinated skelatal muscle contraction
**Akathisia
***subjective sensation of intense motor restlessness
***may be misdiagnosed as manifestation of psychiatric disease
*Parkinsonism
**onset weeks to months after starting medication
**similar presentation to [[Parkinson's disease]] (e.g. cogwheel regidity, pill-rolling tremor, shuffling gait, bradykinesia)
*Tardive dyskinesia
**usually irreversible or only partially reversible
**associated with prolonged use of antipsychotics
**sterotyped, repetitive facial movements (e.g. tongue protrusion, grimacing, lip smacking)

==Differential Diagnosis==
*[[Neuroleptic malignant syndrome]]
*[[Serotonin syndrome]]
*[[Hypocalcemia]]
*[[Strychnine]] toxicity
*[[Acute tetanus]]
*[[Parkinson's disease]]
*[[Mono amine oxidase inhibitor toxicity]]
*[[Phencyclidine toxicity]]
*[[Anti-NMDA receptor encephalitis]]

==Evaluation==

==Management==
*Stop or reduce offending agent
**may need to discuss with psychiatrist to prescribe new medication or for recs on taper
*Acute dystonia, akasthisia, parkinsonism
**[[diphenhydramine]] 25-50mg PO or IV
**OR benztropine 1-2mg PO or IV/IM
**continue PO antihistamines for 2 days after stopping antipsychotic
**+/- [[benzodiazepines]]
*Tardive dyskinesia
**may only be partially reversible, so minimize occurrence, stop or reduce offending agent promptly
**Do NOT give anticholinergics, will exacerbate symptoms

==Disposition==

==See Also==
*[[Antipsychotics]]
*[[Dystonic reaction]]

==External Links==

==References==
<references/>

[[Category:Toxicology]] [[Category:Neurology]]