Clinical Review Fortnightly review

Acute dystonia induced by drug treatment

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7210.623 (Published 04 September 1999) Cite this as: BMJ 1999;319:623
  1. Peter N van Harten, director, psychiatric residency programme (zonenschild.a-opl@wxs.nl)a,
  2. Hans W Hoek, associate professorb,
  3. Rene S Kahn, chairmanc
  1. a Psychiatric Center Zon and Schild, Utrechtseweg 266, 3800 DB Amersfoort, Netherlands
  2. b Parnassia/Leiden University, Albardastraat 100, 2555 VZ The Hague, Netherlands
  3. c Department of Psychiatry, University Hospital Utrecht, Heidelberglaan 100, 3584CX Utrecht, Netherlands
  1. Correspondence to: P N van Harten
  • Accepted 28 April 1999

Acute dystonia induced by drug treatment can be a side effect of treatment with antipsychotic drugs and other drugs, and it may occur at an early stage of treatment.1 2 Acute dystonia is often frightening and may seriously disturb the relationship between the doctor and the patient. Therefore, every doctor who prescribes dopamine blocking agents should be familiar with the prevalence of and the risk factors for acute dystonia and should know how to prevent and treat the condition.

Summary points

Acute dystonia induced by drug treatment can be caused by antipsychotic, antiemetic, and antidepressant drugs

Acute dystonia caused by drug treatment can seriously disturb the relationship between doctor and patient and should be prevented

Patients who develop abnormal positioning or muscle spasms within seven days of starting drug treatment or of a rapid increase in the dose of a drug may be diagnosed with acute, drug induced dystonia

Biperiden 5 mg should be administered intramuscularly to treat the condition; this is nearly always effective within 20 minutes

Risk factors for acute, drug induced dystonia include young age, male sex, use of cocaine, and a history of acute dystonia

Drug induced dystonia can be prevented either by adding, during the first four to seven days of treatment, anticholinergic drugs to treatment with antipsychotic drugs or by starting treatment with atypical antipsychotics

Methods

We searched Medline and Embase for the period 1980-98 using the key terms extrapyramidal syndromes, dyskinesia, dystonia, movement disorders, side effects, and antipsychotics, and we checked the reference lists of the articles that we identified. This information supplemented our own research into extrapyramidal side effects induced by antipsychotic drugs.35

Prevalence and risk factors

Acute dystonia induced by antipsychotic drugs is described as “sustained abnormal postures or muscle spasms that develop within seven days of starting or rapidly raising the dose of …

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