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Improvement in neuroleptic-induced akathisia with intravenous iron treatment in a patient with iron deficiency
  1. Paul E Cotter,
  2. Shaun T O’Keeffe
  1. Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
  1. Correspondence to:
 Dr S T O’Keeffe
 Unit 4, Merlin Park Regional Hospital, Galway, Ireland;s.okeeffe{at}mailn.hse.ie

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Iron deficiency may play a role in the pathogenesis of drug-induced akathisia, but the evidence is conflicting.1–3 There have been no reports of the effect of iron treatment in this condition. We report the case of a patient with iron deficiency whose akathisia had not responded to standard interventions but did respond dramatically to intravenous iron treatment.

A 68-year-old man with schizophrenia had been well controlled for 10 years on thioridazine 150 mg/day. His treatment was changed to respiridone 1 mg twice daily. Within 2 weeks, he had developed a severe sensation of inner restlessness and anxiety associated with increased leg movements and body rocking. No depressive or psychotic symptoms were noticed, although the patient was greatly distressed. Acute drug-induced akathisia was diagnosed.

No improvement in akathisia symptoms was noticed when the dose of respiridone was reduced or when respiridone was discontinued and thioridazine restarted. Therapeutic trials of alprazolam, benztropine and propranolol failed to alleviate his symptoms and led to side effects.

When seen in our clinic, the patient had had symptoms for >6 months. He reported a “terrible feeling” of restlessness and anxiety “gnawing inside me” each day. Symptoms were present throughout the day, with no worsening at night, …

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