Type of EPS

Clinical features

Treatment

Acute dystonia

Acute muscle spasms:

– Eyes

– Head

– Neck

– Limbs

– Trunk

– Benztropine 2 mg IM and continue 1-2 mg PO bid for 2-3 days; or

– Diphenhydramine 25-50 mg IM/IV every 4-6 h as needed

Parkinsonism

– Tremor

– Bradykinesia

– Rigidity

– Flat affect

– Benztropine 1-4 mg PO bid; or

– Diphenhydramine 25 mg PO bid

– Consider switching first-generation antipsychotic to second-generation or lower-potency antipsychotic

Akathisia

– Restlessness (lower extremities)

– Pacing

– Inability to stand still

– Rocking from foot to foot

– Decrease dose of antipsychotic

– Consider switching antipsychotic

– Propranolol 10-80 mg PO daily or in divided doses

– Consider clonazepam 0.5 mg PO daily for short duration

Tardive dyskinesia

Nonrhythmic and quick movements:

– Oral-buccal muscles

– Tongue

– Pharynx

– Trunk

– Diaphragm

– Consider preventative measures

– Switch to clozapine may decrease movements

– Valbenazine 40-80 mg PO daily; or

– Deutetrabenazine 6-24 mg PO bid