5-HT2A Receptor Antagonists for Neuroleptic Induced Akathisia


This systematic review and meta-analysis published in 2014, compared the efficacy of 5-HT2A receptor antagonists for neuroleptic induced akathisia. This was the first meta-analysis on this topic and first to report effect of this medication class.

 


Methods:

 

  • Six randomized controlled trials were found, five of which included a placebo control group and qualified for our meta-analysis. 

 


Results:

 

Three medications with 5-HT2A Receptor Antagonists property:

  1. Mirtazapine

  2. Mianserin

  3. Trazodone

 

WHICH MEDICATION HAVE FAVORABLE SIDE EFFECT PROFILE:

  • Mirtazapine seems to have a more favourable side effects profile than Mianserin and Trazodone.

  • Mianserin and Trazodone have adrenolytic properties:- somnolence, sedation, impairment of cognitive functioning and circulatory problems.

  • Mirtazapine do not have adrenolytic properties and can thus be better tolerated when combined with antipsychotics, which themselves exhibit α1-receptor blockade.

 

  • For adverse effects and drop-outs:  no significant differences between medications and placebo groups.

  • Note that reduction in akathisia severity was NOT accompanied by a reduction in severity of psychotic symptoms.

 

WHICH MEDICATION IS MORE EFFICACIOUS:

  • Because of the small number of trials, no differences in efficacy among the three agents used (i.e. mirtazapine, mianserin and trazodone) can be detected. 

 

WHAT DOSE OF MEDICATION WAS FOUND EFFECITVE:

  • Mianserin: low dose of 15 mg daily. 

  • Mirtazapine: low dose of 15 mg daily.

  • Trazodone: 100 mg daily. 

 


Do share your clinical experience with 5-HT2A receptor antagonists for neuroleptic induced akathisia.

 


Source:
  • Int J Neuropsychopharmacol. 2014 May;17(5):823-32.

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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