Posted by ed_uk2010 on December 1, 2013, at 6:24:31
In reply to Re: Akathisia question. » ed_uk2010, posted by sigismund on November 30, 2013, at 17:29:23
Hi Sigi,
> When I had the dystonic, I actually felt that my jaw might be ripped off its hinges, it was that bad. Seemed to be mainly there, but perhaps I had taken SO much Valium that I could not notice any other feelings of restlessness? It was alarming to go through and must have been difficult to watch.
It is horrific. I expect you would have been very restless without the Valium. But Cogentin (or similar) is usually needed for dystonia.
Although Torecan isn't used anymore in most countries, very similar dopamine antagonists are used extremely widely for nausea and vomiting. They are prescribed almost reflexively by some doctors eg. prochlorperazine, metoclopramide. Check out any anti-sickness med you ever get in future. If it's a potent dopamine antagonist, ask for something else. Domperidone (Motilium etc) is the only DA antagonist which almost never causes dystonia or akathisia, but it's not available in some countries (the reason for this is that when it originally came as an IV formulation, it caused cardiac arrhythmias. The tablets seem OK though, for short-term use only).
Antiemetics which *almost never* cause dystonia/akathisia:
Ondansetron (Zofran etc). Very useful for chemo nausea/vomiting, post-op vomiting and severe gastro-enteritis. Increasingly popular for multiple uses.
Granisetron (Kytril etc). Similar to ondansetron.
Palonosetron - a bit like a very potent long acting version of ondansetron, using to great benefit during chemo.
Aprepitant (Emend) - used mainly during chemo.
Dexamethasone (normally used as an add-on to ondansetron during chemo, not so much for other types of nausea).
Cyclizine, meclizine, diphenhydramine, dimenhydrinate (Dramamine) and similar anticholinergic antihistamine antiemetics. Useful for travel sickness but cyclizine is used for pretty much all types of vomiting over here.
Cinnarizine (Stugeron etc). Uses for inner ear disorders (eg. labyrinthitis) and motion sickness.
Betahistine (Serc, Betaserc). Not so much an antiemetic, but used to speed improvement of inner ear disorders causing vertigo and vomiting.
Hyoscine hydrobromide (eg. Kwells). Useful for severe travel sickness.
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Antiemetics which occasionally cause akathisia:
Promethazine (Phenergan) - but almost never dystonia. Very sedating.
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Antiemetics which should be *avoided* by pts prone to dystonia or akathisia:
Prochlorperazine (Stemetil, Compazine etc)
Metoclopramide (Reglan, Maxolon etc)
Haloperidol (Haldol, Serenace)
Droperidol
Perphenazine
Trifluoperazine (Stelazine)
Chlorpromazine
Thiethylperazine (Torecan - discontinued most places).Some of the above drugs may be perfectly tolerable at very low doses, but beware, seriously. Anyone who has had bad reactions before is at risk of having one again. Akathisia is dose-dependent so large doses are to be approached with special care.
poster:ed_uk2010
thread:1054308
URL: http://www.dr-bob.org/babble/20131115/msgs/1055131.html