Detection, Prevention, and Management of Extrapyramidal Symptoms

Tamra Jean Courey,MSN


Journal for Nurse Practitioners. 2007;3(7):464-469. 

In This Article

Clinical Management of Symptoms

Managing EPSs can be challenging even if a screening tool is used, because the interventions must be based on the specific category of EPSs being displayed. Most EPSs will subside with discontinuation of the APM or replacing the medication with an AAPM. In some cases, lowering the dose may provide relief, except for tardive dyskinesia, which is unpredictable. Symptoms of akathisia typically respond to discontinuation of the APM coupled with anxiolytic medications such as lorazepam (Ativan), diazepam (Valium), or alprazolam (Xanax). -Blockers such as propranolol (Inderal) have also proven effective.[2,5,6] Dystonic reactions, which can develop acutely, require immediate interventions to minimize symptoms. Anticholinergic and antiparkinsonian agents are the first line of defense during acute dystonic reactions ( Table 5 ).[2,5,6] These medications relieve dystonic symptoms within minutes; however, the anticipation for the onset of relief can be frightening to an anxious client who is experiencing involuntary muscle contractions. Many clients will be prescribed anticholinergic or antiparkinsonian medications as prophylactic therapy for EPSs. However, they should be prescribed with caution because the potential risks of lethality with overdose, dependence, psychosis, dry mouth, blurred vision, constipation, tachycardia, urinary hesitancy, dizziness, confusion, and the potential to aggravate tardive dyskinesia.[2,5,13]

Management of tardive dyskinesia begins with prevention of the symptoms. Screening for tardive dyskinesia is strongly recommended at least every 3 to 6 months.[2,6] Other sources of symptom management for tardive dyskinesia are being explored such as treatment with vitamin B6 and vitamin E.[17]


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