Treatment options if EPS occurs If it is possible to reduce the dose of a neuroleptic without compromising the therapeutic effect, this should be tried. However, if the dose of neuroleptic can not be decreased, changing to a neuroleptic that is less likely to cause EPS can be considered. If these alternatives are not available an anticholinergic drug can be added, and continued until EPS are reduced. Review of the literature and clinical experience suggest that acute dystonia will respond well to anticholinergic drugs, while akathisia does not respond very well to these agents. If akathisia is distressing, benzodiazepines such as diazepam or clonazepam should be tried.
Benzodiazepines are particularly useful to suppress motor restlessness and mental distress.
Beta blocker propranolol in doses of 30-80mg has also been used and found to be moderately effective. If EPS continues in spite of an increase in dose of one anticholinergic agent, change to another anticholinergic agent should be considered. The WHO consensus statement on the use of anticholinergic drugs recommends the continuation of anticholinergic drugs for approximately three months after which a slow reduction in doses of anticholinergic drugs should be tried. Drugs should be withdrawn if it is at all possible. If EPS recurs, an anticholinergic drug may need to be reinstituted.