Dystonia responds promptly to the anticholinergic Procyclide 5-10 mg IM/IV/PO or Benztropine 1-2 mg by slow IV injection.
- The best predictor of an acute dystonic reaction is a previous history of having had one.
- Can be quite dramatic and can be seen even after innocuous drugs
- These usually have some central dopamine blocking effects
- Commonest with neuroleptics but also with metoclopramide
- Haloperidol, Olanzapine, Clozapine
- Risperidone, Fluphenazine, Metoclopramide
- Prochlorperazine, cocaine, SSRI, Ranitidine
- Neuroleptics, carbamazepine, erythromycin
- Commoner in young patients
- Oculogyric crises - sustained upward gaze
- Torticollis and Tongue protrusion and Trismus
- Retrocollis, Rarely laryngospasm, opisthotonus
- Macroglossia but tongue does not swell, but it protrudes and feels swollen
- Anxiety, tachycardia, sweating
- Tetanus and strychnine poisoning
- Hypocalcaemia and hypomagnesaemia
- Seizure, pseudoseizure, hyperventilation, meningitis
- ABC and resus if airway compromise with Oxygen and IV fluids
- Consider Procyclidine 5-10 mg IM or IV or PO. Alternatives include Benzatropine (Benztropine) 1-2 mg IV or IM repeated after 20 mins but if fails to work consider another diagnosis
- Diazepam, 5-10 mg IV has been used for the rare patient who does not completely respond to the more specific antidotes.
- Stop offending drug and advice do not give again.