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Anticholinergics for neuroleptic-induced acute akathisia

  • Review
  • Intervention


  • AR Lima,

  • KVS Weiser,

  • J Bacaltchuk,

  • TRE Barnes

Dr Adriano Resende Lima, Medical Postgraduate Student, Department of Psychiatry, Federal University of São Paulo, Vila Clementino, Rua Botucatu, 740 - 3.0 andar, São Paulo, SP 04023-900, BRAZIL.



Neuroleptic-induced akathisia is one of the most common and distressing early-onset adverse effects of conventional antipsychotic drugs, being associated with poor compliance with treatment, and thus, ultimately, with an increased risk of relapse. This review assesses the role of anticholinergic drugs as an adjunct to standard antipsychotic medication in the pharmacological treatment of this problem.


To determine the clinical effects of anticholinergic drugs for neuroleptic-induced acute akathisia.

Search strategy

The reviewers undertook electronic searches of Biological Abstracts (1982-1999), CINAHL (1982-1999), Cochrane Library (Issue 4 1999), Cochrane Schizophrenia Group's Register (October 1999), EMBASE (1980-1999), LILACS (1982-1999) , MEDLINE (1966-1999) and PsycLIT (1974-1999). References of all identified studies were inspected for more trials and first authors contacted. Each included study was sought as a citation on the Science Citation Index database.

Selection criteria

All randomised clinical trials of anticholinergic drugs versus placebo for people with neuroleptic-induced acute akathisia.

Data collection and analysis

Two reviewers, working independently, selected, quality assessed and extracted data. These data were then analysed on an intention-to-treat basis. For homogeneous dichotomous data the fixed effects relative risk (RR), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, reviewers calculated weighted mean differences.

Main results

No randomised controlled trials could be included.

Authors' conclusions

At present, there is no reliable evidence to support or refute the use of anticholinergics for people suffering from neuroleptic-induced acute akathisia. Akathisia is a most distressing movement disorder that remains highly prevalent, both in the developed and developing world. This review highlights the need for well designed, conducted and reported clinical trials to address the claims of open studies as regards the effects of the anticholinergic group of drugs for akathisia.

Plain language summary

Plain language summary

Akathisia is a common and distressing adverse effect of many antipsychotic drugs. It is characterised by restlessness and mental unease, which can be intense. It is associated with patterns of restless movement, including rocking, walking on the spot when standing, shuffling and tramping, or swinging one leg on the other when sitting. People may constantly pace up and down in an attempt to relieve the sense of unrest. Several strategies have been used to decrease akathisia, and this review is one in a series addressing the effects of drug treatments. We found no trial-based evidence for the use of anticholinergic drugs for akathisia, thus making firm treatment recommendations impossible.