Sudden Akathisia After a Ziprasidone Dose Reduction

In a letter to the editor from March 2006, the authors reported on five female patients with bipolar disorder who experienced sudden akathisia following a reduction in their ziprasidone dosage. These patients, aged between 27 and 61, were initially treated with 80–160 mg/day of ziprasidone. Upon dose reduction, they developed akathisia, characterized by an irresistible urge to move and motor restlessness, with Barnes Rating Scale for Drug-Induced Akathisia scores ranging from 6 to 14. None had significant medical conditions related to akathisia. Treatments for akathisia included propranolol, diazepam, biperiden, and clonazepam, which led to a 75% to 100% reduction in Barnes rating scale scores and resolution of akathisia within 7–10 days. This case series highlights the potential for unexpected extrapyramidal side effects, such as akathisia, with second-generation antipsychotics like ziprasidone, both during treatment and upon discontinuation.