can clonidine treat akathisia symptoms?

[mustafasonmez]

Dear member's
I need some advice about (neuroleptic) halodeperial induced akathisia.
My mother suffered frontotemporal dementia illness. She's 71 years old. She has some hallusulations and psycosis due to the FTD.
Approx 4 months ago she became very aggressive and she suffered insomnia. The doctor's gave her risperidone, ketiapin (seraquel) , xanax, diazem, ativan (lorezepam) alternately during the four months period.
But these drug's are not to be successful for controlling aggressive behaviour. and insomnia.
After then the Doctor's gave her 2 x 5 mg halodoperial (norodol) tablet for controlling her behaviour.
After taking halodoperial 4 week; she catched halodoperial induced akathisia and dystonia on her neck muscle.
Her akathisia very violent. She walks in the house continually approx 18 hours in a day.
She never sit. She never rest. She always walk.
She also eat meals if and only if during the walking movement.
When the sleeping (night time) time come; we give her imovane (zopiclone), melatonin and 150 mg seraquel mixture; also this drugs can help her only 6 -7 hours sleeping time in one day.
Fronto temporal dementia and dystonia is not so important; but akatisia and her restlesness walking is very hurtful.
How can we stop akathisia syndrome ?
She walks about 40 kilometres per day. The neurologist doctor gave her amantadine (PK-MERZ) pills, tetrabenazine (xenazine pills) and also propranolol (dideral) pills, benadryl and cyropheptadine syrup alternately against controlling akathisia.
But these drugs couldn't control her akathisia. She never sit a chair only more than 0ne-two second during the all day time. Is there anyone who knows akathisia drug?
Could you please advice a drug for controlling akathisia.
I am afraiding of She may became anorexic ; She eats very hardly. because of walking consistently.
I heard clonidine drug Its trade name is catapress. Medical literature says clonidine may help to treat akathisia symptoms.
Would any one suggest us a akathisia recipe and also about using clonidine ?
I am afraid potential bad side effect of clonidine.
Thanks in advance for your comments.
I am lokking forward your advices.
Best regards.
Mustafa Sönmez
[email protected]

 

[aced126]

I'm not a professional but on Wikipedia if says propanolol may be helpful to treat akathisia. Clonidine, though via a different mechanism of action, could have a similar effect. The article mentioned vitamin B6 to be effective for treatment of neuroleptic induced akathisia.

 

[rabidrick]

Maybe you can ask the doctor about gabapentin; it's pretty innocuous and has some reported success in cases like this where other akathisia drugs fail.

 

[dopamimetic]

Reading through that list of strong psychopharms really hurts somewhat ...

Have to say that I'm by no way a professional and I'll have to yet read up about the FTD.
But the point is that strong dopamine blockade from antipsychotics like haloperidol (at least in my eyes) could very well make things even worse. Dopamine blockade causes a shitload of nasty adverse effects in healthy young people. There are black box warnings not to give some atypical (maybe even Seroquel / quetiapine!?) to the elderly. And the akathisia is a real sign that the dopamine blockade is too strong - it's not a side effect, but a direct effect of that. Pharmacologically induced (extreme) restless legs, if you want so.

Now giving amantadine to alleviate this? Probably because of it's dopaminergic properties. Sigh.

This are just my first thoughts, but you might want to look into trazodone (a sedative antidepressant that's a potent 5-HT2a antagonist and as a such has antipsychotic properties) or clozapine (an atypical antipsychotic - maybe the only really atypical one in that it has somewhat low prevalence for dyskinesia and akathisia- but it also has safety issues) - as a replacement for the haloperidol.

Last but not least, if it's a neurodegenerative thing causing the aggression, memantine might be a valuable option to try. It's an anti-dementia med with neuroprotective and somewhat anxiolytic, calming, maybe anti-aggressive properties! And it is quite safe and better tolerated than amantadine, also stronger. Also it's a dopaminergic, so it will certainly not cause akathisia etc. but rather help with that.

Fronto temporal dementia and dystonia is not so important; but akatisia and her restlesness walking is very hurtful.
How can we stop akathisia syndrome ?

Edit: Really stop the haloperidol & quetiapine then (gradually)- this is causing all that! I'd say try memantine together with a strong sedative at least for the first time, if the zopiclone works keep it, otherwise we'll need to search something better.

Gabapentin- hmm, maybe. If the memantine fails or shows to be too weak, it could be worth a try too.

Maybe I'll have a better idea later.

Take care & hope she'll get better!

 

[MyExcuse]

I've suffered Tardive Dyskinesia since I was a youth. Prescribed high doses of Metoclopramide for about 8 years from 4 onward.

The only thing I've found to work has been sedatives. Clonidine helped with the anxiety caused by the twitching, but not the twitching itself.

Thankfully mine have naturally become less severe over time.

Phenibut helped a ton and it is legal/available. I had a buddy who worked as a hospice nurse and would experiment with his patients. He found a great degree of utility with Phenibut in late dementia, Parkinsons and ALS patients. Would recommend.

 

[dopamimetic]

MCP can be really bad, yes - it's speculated as being one of the overall main causes for tardive dyskinesia despite it doesn't show strong acute antidopaminergic properties usually (at least when I used it at low-regular dosages for nausea, I didn't feel anything and I'm very sensitive to dopamine antagonism - but this can very well vary between individuals and especially be much worse in children, having a weaker blood brain barrier).

Interesting that phenibut helps so much here. To try baclofen (more selective as a GABA-B agonist) and gabapentin / pregabalin (more similar to the other pharmacologic properties of phenibut) might help to further explore what the relevant mechanisms are and how to minimise addiction / withdrawal potential!

It might be a mixture / synergy of both mechanisms - but I'd speculate that the calcium channel modulating / blocking effects are more relevant?

 

[mustafasonmez]

Thanks for all your comments. I am very grateful for your any advices.
Neuroleptic induced akathisia is very specific matter.
There isn't a doctor who has fully experienced on this illness. Your comments are very valuable for us.
Now I am starting to give this recipe against for my mother's violent akathisia.
Clozapine 12,5 mg -1 piece X 1 day (against dementia psycosis also akathisia but we prefer to give low dose because we afraid if blood count changes)
Clonidine 75 mcg -2 piece X 1 day (she has hypertension problem about 20 years period. May be clonide can useful both of akathisia and hypertension, we left inderal (propranolol) . Because clonidine and inderal may interact eachother and also may cause hypotension)
We start Gabapentin 400 mg 1X 1 day.... after 3 day pass; I will increase this dosage 2 piece of 400 mg X 1 day (ıt may fight akathisia and it may help her to be calm)
For sleeping aid againsst insomnia ; immovane (zopiclone) and melatonin ( We left seraquel because of it may support akathisia and extrapyramidal symptoms)

We start this recipe yesterday; I want to share with you first indications;

1) I gave her first gabapentin at 17:00 o'clock; when the time come 11 o'clock she sleep by herself; she wake up 7 o'clock morning; we are so suprised because this night is a first time she don't need to take imovane(zopiclon) and melatonin for sleeping. But in the morning she has very aggressive; I think if we increse gabapentin dose 2 times 400 mg per day; may be she will become more calm all day time. Would you please evaluate my opinion?

2) I want to talk about clonidine pills performance. yesterday I gave her 2 piece 75 mcg clonidine but I measure her tension as 16/9,5; I evaluate 16 value; It is high value. Now I am thinking of only one piece inderal (propranolol) adding this drug list for controlling tension and akathisia? Would you please evaluate my opinion?

3) I wonder drug interaction betweeen gabapentin and immovane(zopiclon) ; ıf my mother take them together against akathisia induced insomnia ? Is it correct way?

4) Is there anyone who knows drug interactions beetween clozopine, clonidine, propranolol (inderal), gabapentin, imovane (zopiclon); if there is a incompatible pair please warn me against bad side effects?

We extremely need for your help and your advices;

Thanks in advaces for your kind replies.
Mustafa

 

[mustafasonmez]

This morning she's very offensive and aggressive
I don't know which drug can caused this aggressive behaviour? I am planing to increase gabapentin dosage 400 mg -2 pieces a day
gabapentin may control her aggressive behavior.

 

[dopamimetic]

Hi Mustafa,

happy to hear that she's improving - so you completely stopped the haloperidol & quetiapine and switched her to low dose clozapine? That's good for now, because the strong antipsychotics are really horribly toxic in my eyes and the whole dopamine blocking theory is probably flawed - but I'd really recommend to try go completely off any dopamine blockers in the future and see how she reacts to memantine, because this is a drug specifically for dementia that's neuroprotective, antipsychotic and anticonvulsant as well as it's D2 agonism will contribute to help with the akathisia!

But ... the gabapentin might be a very good thing then indeed, and maybe a higher dose of it alone can be sufficient and remove the need for additional antipsychotics! You'll need to dose 3-4 times a day because of it's relatively short half life. If it is available in your country, pregabalin (Lyrica) has a better bioavailability and more linear pharmacokinetics - it's kind of gabapentin with improved biological properties.

Gabapentin might well solve all the issues - it calms the over excitation that might lead to aggression and the underlying worsening of dementia (which shows as psychosis but it isn't - psychosis and schizophrenia are somewhat obsolete terms in my eyes, they are neurological conditions that can't be seen independent as mental vs. neurological things)

2) You can safely increase the clonidine dosage by 50-75mcg per day and give it in at least 2-3 doses per day to achieve constant plasma levels. Clonidine is pretty safe but it tends to cause rebound hypertension if one forgets to take it. But if it's not enough or does sedate her too much, I'd consider carvedilol, because that's a beta blocker which additionally also blocks alpha receptors and thus doesn't share the problems of potential vasoconstriction etc. other beta blockers have.

3) Gabapentin and zopiclon will potentiate the sedative effects of each other and the combination could potentially lead to sleep walking etc. because zopiclon has some delirant properties by a not-yet-known mechanism ... but if needed, at a very low dosage (3.75mg might well be enough!) it should be pretty safe.

4) Mostly what I've described above. Clonidine and propranolol can be given together but I'd recommend against it if one of them is too weak and rather chose another agent or increase the dosage.. but my primary concern is the clozapine that you probably don't need really.

Best wishes (and am really shocked somewhat that I have to give these advices here instead of some well-educated and experienced professionals when I'm not even allowed to university yet due to shitty bureaucracy, but well I know the reality and have struggled to find competent doctors too.. it's just ridiculous..)
-dopamimetic

 

[mustafasonmez]

Thanks for your replies. I read all of them carefully.
My mother's drug program include;

Morning...clonazepam 12,5 mg
Lunch time..... mianserin 10 mg
Afternoon........propranolol 40 mg
bed time ; as a anticonvulsant gabapentin 400 mg, imovane and melatonin mixure (But she sleeps only 7 hour)

She left seraquel and halodoperial.

She takes these drugs against halodoperial induced akathisia and dementia psychosis.

All these medice couldn't be successul for slowing and controlling akathisia symptoms.

Unfortunately she never sit. She always walk.

For example when she sit toilet pan for wee action after 2 second pass, she suddenly jump to her feet; half of her weewee spill out of the toilet pan. This is very upsetting for us.

In living room she never sit on any comfortable chair more than 2 second.

This akathisia is really violent akathisia. We can't feed her; because she always walk in home.

I designed a special chair like a cage. When the meal time come; we lock her in a special chair, after we try to feed her.

She has also neck dystonia; but it's not important; but dystonia is an important sign of etrapyramidal symptoms same like akathisia.

I noted drug list above; I know that creating sedation with some drugs is very harmful on frontotemporal dementia patient's.

She used memantine pills 2 year ago she takes memantine 6 months period. It's not useful on FTD illness. In pubmed internet site a clinic research published that explain memenatine doesn't any benefical efect on frontotemporal dementia patients.

Would you please advice us different kind of drugs and/or correct dosages against violent akahisia?

Regards
Mustafa

 

[SKL]

The first thing that should've been done is the offending agent (likely the Haldol) discontinued. Glad that this has been done. How long ago? It's possible that this situation will resolve itself but it can be long lasting and in any case in the interim it needs to be treated because it's a serious issue obviously and causes a great deal of distress to the patient.

As far as the meds go, usually the best thing to do is, like Thoreau, "simplify, simplify." It's good that you are doing this but this also needs urgent intervention.

Some ideas:

1. Ativan over Klonipin (watch for oversedation, fall risk, start around 0.25-0.5mg, be careful tapering up)
2. Cogentin over Benadryl (cogentin=less delirium risk, start also around 0.5mg, up to 2mg, tapering slowly) other alternatives, cyproheptadine, Artane.
3. Propanolol over Clonidine (watch blood pressure, start at 10mg, if tolerated an go considerably higher ... I see you are at 40mg already ... if blood pressure allows you can go higher)
4. Gabapentin may help, pregabalin may be better, if tolerated could increase, could take a small dose in the morning as well or even split doses 2-3x/day and a stronger dose at night, may be helpful in managing symptoms during the day

All of the above can and likely should be given in divided doses, 2 or 3 times a day. Caution if liver or kidney issues though.

5. Consider stopping everything else for a brief interval to see if anything changes. As with any drug holiday things may get better before they get worse.

Some good suggestions above to but this would be my first approach.

For behavioral management Haldol obviously should never be used again. An atypical neuroleptic could be considered (Zyprexa, Abilifty, Geodon) but nothing should be done until the akathisia is addressed. Yes they are risks in the elderly but everything is a cost benefit analysis.

I hope things get better for your mom and best wishes.

STRONG DISCLAIMER: This is not medical advice. I cannot assess the patient and I cannot prescribe or suggest with any professional authority treatment over the Internet. It is imperative that this be done under the supervision of a physician, preferably a geriatric psychiatric specialist.

 

[dopamimetic]

4. Gabapentin may help, pregabalin may be better, if tolerated could increase, could take a small dose in the morning as well or even split doses 2-3x/day and a stronger dose at night, may be helpful in managing symptoms during the day

Gabapentin has a relatively short half life (5-7h) and should definitely be given in 3-4 doses a day if it's helping, also it's not that well absorbed when given too much at once - a larger dose at night but the rest split throughout the day!

Also propranolol is just active for 4-5 hours as long as it's not delivered in retard capsules.

--

I'm really too unsure about this to give any advice, so I'm just asking for now also because I'm curious about the mechanisms as well - but I feel somehow that the antipsychotic-induced akathisia is kind of a severe drug-induced form of restless legs and mostly dopaminergic? So when the haloperidol is discontinued and it still doesn't go away, could a dopamine agonist help?

From wikipedia:

One study showed vitamin B6 to be effective for the treatment of neuroleptic-induced akathisia.[27]
N-acetylcysteine also showed a positive effect on akathisia in a randomized control trial.[28]

The latter seems to generally make a good supplement for quite a few mental / neuronal things (antioxidant) if you look at recent evidence- as long as it's tolerated.

 

[Kittycat5]

If mirtazapine is available, try to get her on that. 15mg once daily is at least equivalent to 40-80mg of propranolol for treating akithisia. Furthermore, it has a more favorable side effect profile. Nearly every drug you listed is on the Beers List for drugs to be avoided in patients 65 and older due to inappropriate adversve events, and while mirtazapine is under consideration for inclusion, currently it is only being warned to use with caution in geriatrics. I think this case is appropriate.

It also has the added benefit of improving both sleep and appetite, something you seem concerned about in your mother's current state.

If mirtazapine cannot be used, increase mianserin to 15mg and propranolol to 40mg twice daily. Monitor her blood pressure, heart rate, and be cognizant of any changes in mental status with the increased propranolol.

May I ask if she is experiencing lonlieness or boredom? Akathisia can sometimes be treated through distraction techniques, increased activity of a productive nature, or even through various concentration exercises. Feeling alone, isolated, or bored can often make a person focus on their restlesness to the point it manifests more severely. I understand a behavioral or occupational type therapy may be difficult in a patient with dementia, but it can be relatively minor things that make an impact. I read a case report where akithisia was helped with a pedalling device (like a bicycle) and considering your mom walks 40km daily, she certainly could do something similar.

The other thing I am wondering is if the Imovane or benzodiazepines are having a paradoxical effect. Based on the timeframe of when the akithisia started you mentioned, I cannot decide if this is a valid conclusion, but there are reports of akithisia in patients attributed to benzos and other sedatives.

The current theories of neuroleptic induced akithisia are still heavily based on the dopamine blockade theory. But the fact that serotonergic, gabaergic, and adrenergic drugs all have use in treatment and that second generation antipsychotics with weak dopamine antagonism can still cause it, show it isnt the whole story. Of course the interplay of all these systems occurs and may ultimately lead to less dopaminergic tone, but it still isnt fully worked out.

 

[mustafasonmez]

I want to give my mom a dopamine antogonist for treating haldol induced akathisia and dystonia. Pramipeksol or amantadine or another one? Which one is better? I confused. Please advice us which dopamine agonist may useful ? thanks in advance

 

[Kittycat5]

Amantadine and ropinerole have been tried with some success, not great in all cases. I imagine pramiprexole may work, too.

 

[dopamimetic]

These meds probably won't hurt when used carefully and might be worth to try, but amantadine can be somewhat more confusion inducing than memantine at least based on my own anecdotal evidences. Memantine's overall a bit calming and sedating (but not in a chemically locking way, just slowing that glutamate excitatory activity) and a decent dopamine agonist too.

 

[JA CarterW]

Hello,

I'm coming in late to this party, and I'm new, but I'm happy to be here. First, Mustafa, the information you're getting here is spotty, at best. I don't mean any disrespect. Everyone here is or was, trying to help, and based on what we know now, in 2018 v. what we knew in 2015 is extensive.

I am not a medical profession, and I can't give you medical advice, but I can tell you my experience, and what I've found through EXTENSIVE research. The reason? I have tardive, drug-induced akathisia, and have suffered with it for about 14 years. The cause was atypical anti-psychotics. They are the WORST offenders, and whoever urges you to put your mother on them didn't have this info at the time because it was NOT made available to us (the public).

I stopped my AAP (Latuda) in August of 2016, and I began to MOVE in February of 2017. I have tardive akathisia, tardive dystonia (many types including cervical, like your mother, and oral-mandibular) and tardive dyskinesia, not just of my mouth, but my whole body. And I get it--the dystonia, the dementia; it's NOTHING compared to the horror of akathisia. I could take ALL of these and the accompanying pain of them, if I could only find a way to stop akathisia, the inner feelings it generates.

First, Vitamin B has negligible, if zero effect in treating akathisia, from personal experience and based on the studies and research.

Second, Gabapentin (Neurontin) is hardly innocuous. ANY medication that is psychiatric, no matter what, except, according to the NCBI website and PubMed, which are reliable sources, list that Lithium (in terms of a psychiatric drug) is the least likely to cause akathisia. But that is primarily for mood stabilization for folks who have bipolar disorder.

The use, and discontinuation of almost ALL psychiatric medications either cause drug-induced akathisia, withdrawal akathisia, or tardive (meaning late appearing, long after you discontinue the drug) akathisia. This includes SSRI and SNRI antidepressants, any benzos (anti-anxiety meds), Seroquel causes akathisia. Memantine causes akathisia. Akathisia is also a withdrawal effect of these meds, as well as opiates. BTW, Metoclopramide ALSO causes akathisia.

Almost every drug listed by everyone here, with the exception of Vitamin B and propranolol, cause akathisia. And as you see your mother suffer, understand you have no idea how badly she IS suffering. It is horrific, and the biggest challenge of my life. I have been debilitated by it.

I am trying to raise awareness so people don't even TAKE the drugs that cause it, and instead find other ways to deal with their issues with safer, non-addicting medications, although opiates are addicting, frankly, the pain of akathisia is so bad, opiate dependency is a small price to pay, IMO. BUt that's the point of awareness: make sure no one gets addicted (when I say "addicted," I'm talking about dependence in the sense that once you take them, you cannot discontinue without serious withdrawal effects, including akathisia, so terrible, you never want to feel that way again, so you stay on the drug, even though it does nothing to help you emotionally.)

For a list of drugs that cause akathisia, here is a list, but it is not all-inclusive, meaning there are more than have been added to this list. The website is

https://www.akathisia.life/drugs-that-cause-akathisia

Everything on this site comes from verifiable sources.

The ONLY thing shown to stop akathisia and the accompanying pain (not only outer restlessness, but the inner subjective feelings of terror, panic and pain, emotional pain) has been opiates, and from personal experience, Clonidine. Propranolol might treat mild cases of akathisia, and helps me so that I can walk properly again--I had to re-learn how to walk last year--but it does not help severe akathisia, except, from my experience, the shaking, jerking, muscular restlessness.

I recently read that MAOI medications have had some successful trials w/r/t treatment of tardive akathisia, one called moclobemide, but there are others, I'm sure.

An OTC medication that works wonders for acute akathisia pain? Zzquil. It has the same ingredient as Benadryl, without making you dry up. I have to "micro-dose" Zzquil during the day, usually 1/4 to 1/2 a cup (15 ml. or less) to take the edge off of the pain. It's not addictive, does not cause akathisia (such as Seroquel) and there's no withdrawals if you don't take it.

Anti-anxiety meds do NOT help akathisia and in fact are more difficult to withdraw from than even opiates, but AAPs are worse than anything, and withdrawal, depending on how long you take them can take the rest of your life.

The AAPs are especially dangerous as the MASK they symptoms of akathisia, while causing permanent brain damage (TD, dystonia, akathisia) so that when and if the patient starts feeling the akathisia when the drug can no longer mask it, coming off the drug, you get worse, and it may be (probably IS) permanent.

For reliable information, look at PubMed, the NCBI-NIM and MedScape sites for accurate, new research and medications. Get yourself educated about these drugs.

For the record, I am not "anti-drug" or anti-medical/pharmaceutical intervention. I AM pro-information and pro-transparency w/r/t drug trials and patient information when they are given these medications.

SSRI, SNRI antidepressants? They DO NOT WORK. Period. They are only a placebo-effect phenomena. There is exactly zero scientific evidence or basis for their use, and they should be, in my opinion, taken OFF the market. You want proof? Read the studies done by Dr. Irving Kirsch based on the clinical trials of these medications themselves done by the drug companies.

Or, a logical approach as we look at anti-depressants: when a drug works to stop pain, there will ALWAYS be a need for them on the black market. That's why people abuse opiates. THEY WORK. Have you EVER heard of people walking to a dealer and begging him for a Prozac? A Zoloft? Pristiq? "Come on man, I'm hurtin' REAL bad, please, you gotta give me a Lexapro man!"

Yeah. NO. If they worked, people would be buying them on the black market. Addicts, dealers, junkies, they know what works and what doesn't. And the reason everyone is addicted to opiates, all over the world, the "Opidemic?" It's because it's THE ONLY way to stop akathisia pain. And with 1 in 4 AMERICANS taking one or more akathisia-causing drugs, it's not a huge leap to figure out why there IS an "opidemic." So people get on an opiate, sometimes by accident, like with a dental surgery etc. and they notice their horrible "anxious, agitated depression, anxiety, PAIN they've been dealing with that their doctor keeps blaming on a "psychiatric illness," is gone after one dose of Norco. When they stop taking the Norco or whatever it is, if they are on psych meds and have akathisia, the akathisia comes roaring back. Welcome to the genesis of the "Opidemic."

I'm sorry the outlook is so bleak. But until people stop blindly listening to doctors, who are beholden to the money-making machines of Big Pharma, we are all in for a horrific ride, I'm afraid.

Good luck to you.

 

[Hodor]

[/I]Or, a logical approach as we look at anti-depressants: when a drug works to stop pain, there will ALWAYS be a need for them on the black market. That's why people abuse opiates. THEY WORK. Have you EVER heard of people walking to a dealer and begging him for a Prozac? A Zoloft? Pristiq? "Come on man, I'm hurtin' REAL bad, please, you gotta give me a Lexapro man!"

Yeah. NO. If they worked, people would be buying them on the black market. Addicts, dealers, junkies, they know what works and what doesn't. And the reason everyone is addicted to opiates, all over the world, the "Opidemic?" It's because it's THE ONLY way to stop akathisia pain. And with 1 in 4 AMERICANS taking one or more akathisia-causing drugs, it's not a huge leap to figure out why there IS an "opidemic." So people get on an opiate, sometimes by accident, like with a dental surgery etc. and they notice their horrible "anxious, agitated depression, anxiety, PAIN they've been dealing with that their doctor keeps blaming on a "psychiatric illness," is gone after one dose of Norco. When they stop taking the Norco or whatever it is, if they are on psych meds and have akathisia, the akathisia comes roaring back. Welcome to the genesis of the "Opidemic."

Ok, this is where you lost me, because that argument makes no logical sense.

By your logic, tylenol, aspirin or ibuprofen must be completely ineffective for pain, because there isn't a thriving black market for them. Same with benadryl - only black-market quaaludes for me, thank you very much. Caffeine? Nah, total garbage. I'll have what the junkies are having, and they're having meth and crack cocaine.
Did it ever occur to you that maybe the reason people buy black-market fentanyl but not sertraline is that fentanyl gets you high as fuck and is hard to get prescribed, whereas Zoloft doesn't get you high and is easy to get a script for? And honestly, do you really think that most opioid addicts are suffering from drug-induced akathisia? Why did people in 19th century China do all that opium, then?

Come to think of it, I also don't see a black market for chemo meds, but there is a thriving black market for rhino horn. Does that mean that powdered keratin from endangered animals really is the ultimate panacea?

 

[Limpet_Chicken]

Clonidine CAN help, a LOT with akathisia. This is from personal experience. Tizanidine works better (its also an alpha2 adrenergic autoreceptor agonist. Opioids help (if she has frontotemporal dementia, she is as good as dead already so longterm isn't going to be THAT long-term to begin with. Its the sort of situation IMO where desparate measures can be taken and continued, because the patient WILL die. I'm sorry to hear that she's in such a shite situation.

Dopaminergic drugs like pramipexole could help. Memantine is a GREAT idea, I've tried it and it stamps on akathisia like it does on opioid withdrawal/tolerance etc.

I'd get the haldol gone asap. That stuff is particularly nasty as far as neuroleptics go, and has a neurotoxic metabolite that acts similar to MPTP. Also, as far as I read, for those with dementia, antipsychotics are often the cause of severe degeneration, particularly bad for dementia patients.

I'd avoid mirtazepine btw. It can, for some people, in even small doses, cause severe akathisia. I got put on it once, and had I not been banged up on remand at the time I might have thrown myself out of a window to stop it, it was that awful.

IMO alpha2 adrenoreceptor agonists would be more likely helpful than beta-blockers.