The Annals New | Pharmaco Epidemiology and Therapeutic Risk Management
home help contact us subscription past issues search current issue
QUICK SEARCH:   [advanced]


     


Published Online, 6 May 2008, www.theannals.com, DOI 10.1345/aph.1K672.
 The Annals of Pharmacotherapy: Vol. 42, No. 6, pp. 841-846. DOI 10.1345/aph.1K672
© 2008 Harvey Whitney Books Company.
This Article
Right arrow Résumé Freely available
Right arrow Extracto Freely available
Right arrow Full Text
Right arrow PDF
Right arrow For Our Patients
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Articles Ahead of Print
Right arrow [Order Reprint]
Google Scholar
Right arrow Articles by Hieber, R.
Right arrow Articles by Nelson, L. A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hieber, R.
Right arrow Articles by Nelson, L. A.

DRUG INFORMATION ROUNDS

Role of Mirtazapine in the Treatment of Antipsychotic-Induced Akathisia

Robin Hieber, PharmD BCPP

Clinical Pharmacist, Western Missouri Mental Health Center, Kansas City, MO

Timothy Dellenbaugh, MD

Director of Residency Training, Western Missouri Mental Health Center

Leigh Anne Nelson, PharmD BCPP

Assistant Professor, School of Pharmacy, University of Missouri—Kansas City, Kansas City

Reprints: Dr. Nelson, Division of Pharmacy Practice, School of Pharmacy, University of Missouri—Kansas City, 2464 Charlotte St., Kansas City, MO 64108, fax 816/512-7478, nelsonla{at}umkc.edu

OBJECTIVE: To evaluate the role of mirtazapine in the treatment of antipsychotic-induced akathisia.

DATA SOURCES: MEDLINE (1966–February 2008) and PsycINFO (1967–February 2008) were searched using the terms akathisia and mirtazapine. A bibliographic search was conducted as well.

STUDY SELECTION AND DATA EXTRACTION: All English-language articles identified from the search were evaluated. All primary literature was included in the review.

DATA SYNTHESIS: Antipsychotic-induced akathisia can be difficult to manage and may respond to mirtazapine based on its antagonist activity at the serotonin 5-HT2A/5-HT2C receptors. Three case reports (N = 9 pts.), 1 placebo-controlled trial (N = 26), and 1 placebo- and propranolol-controlled study (N = 90) that evaluated mirtazapine for antipsychotic-induced akathisia have been published. Mirtazapine demonstrated a response rate of 53.8% compared with a 7.7% response rate for placebo, based on at least a 2-point reduction on the Barnes Akathisia Scale (global subscale; p = 0.004). Using the same criterion, mirtazapine and propranolol demonstrated efficacy based on response rates of 43.3% and 30.0% compared with placebo (6.7%; p = 0.0051). Mirtazapine was better tolerated than propranolol. In both studies, drowsiness was the most common adverse event associated with mirtazapine.

CONCLUSIONS: Mirtazapine may be considered a treatment option for antipsychotic-induced akathisia. It may be especially useful for patients with contraindications or intolerability to β-blockers and for those with comorbid depression or negative symptoms. Additional studies should be conducted to provide further evidence of mirtazapine's effectiveness in treating akathisia.

Key Words: akathisia, extrapyramidal symptoms, mirtazapine

Published Online, May 6, 2008. www.theannals.com, DOI 10.1345/aph.1K672




homecopy help contact us subscription past issues search current issue
Copyright © 2008 by Harvey Whitney Books Company.