In a recent study by Gerolymos and colleagues, the efficacy of various treatments for antipsychotic-induced akathisia was compared to one another to determine which were most efficacious. These researchers examined 15 randomized control trials involving 492 participants and 10 different treatments, which included: mirtazapine, biperiden, vitamin B6, cyproheptadine, trazodone, mianserin, propranolol, clonazepam, zolmitriptan, and valproate. Head-to-head comparisons revealed that mirtazapine, biperiden, vitamin B6, trazodone, mianserin, and propranolol showed greated effects than placebo while cyproheptadine, clonazepam, zolmitriptan, and valproate did not yield significant results. Mirtazapine at 15 mg/day for longer than 5 days, biperiden at 6 mg/day for longer than 14 days, and vitamin B6 at 600-1200mg/day for longer than 5 days were the most efficacious treatments. Trazodone at 50 mg/day, mianserin at 15 mg/day for longer than 5 days, and propranolol at 20 mg/day for longer than 6 days were effective alternatives with slightly less favorable efficacy and tolerance profiles.
Reference:
Gerolymos C et al. JAMA Netw Open. 2024;7(3):e241527. Abstract