Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: A comparative double-blind study

The purpose of this study was to investigate the efficacy of cyproheptadine , an antiserotonergic agent, in the treatment of neuroleptic-induced akathi sia (NLA), as compared with propranolol, the current gold standard. In a do uble-blind trial, 30 patients with schizophrenia and NLA received either cy proheptadine 16 mg/day (N = 18) or propranolol 80 mg/day (N = 12) for 4 day s, followed by 3 days without any anti-NIA treatment. The Barnes Akahisia S cale, Simpson-Angus Extrapyramidal Effects Rating Scale, and Brief Psychiat ric Rating Scale were used to assess the severity of NIA, parkinsonism, and psychosis, respectively. In both groups, the severity of NIA decreased sig nificantly over time (cyproheptadine, -46%; propranolol, -42%), with no sig nificant intergroup difference. The NIA symptoms worsened significantly whe n cyproheptadine and propranolol were discontinued. We conclude that cyproh eptadine 16 mg/day is as effective as propranolol for the treatment of acut e NIA. The antiakathisic effect of cyproheptadine may be mostly attributabl e to its serotonin antagonistic activity.