Dystonic reaction - Revision history

Danbot: Add verified PubMed references (PMIDs 10473482, 29204316)

2026-03-22T10:44:06Z

Add verified PubMed references (PMIDs 10473482, 29204316)

← Older revision		Revision as of 10:44, 22 March 2026
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	==Background==		==Background==
	*Adverse extrapyramidal effect shortly after initiation of new drugs		*Adverse extrapyramidal effect shortly after initiation of new drugs <ref>van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999 Sep 4;319(7210):623-6. PMID 10473482</ref><ref>Jitprapaikulsan J, Srivanitchapoom P. Acute Dystonic Reaction Following General Anesthetic Agent Use. Tremor Other Hyperkinet Mov (N Y). 2017;7:514. PMID 29204316</ref>
	**intermittent spasmodic or sustained involuntary contractions of muscles		**intermittent spasmodic or sustained involuntary contractions of muscles
	*Rarely life threatening but patient is in distress from pain and discomfort		*Rarely life threatening but patient is in distress from pain and discomfort

Danbot: Add MedicationDose entries for benztropine and diphenhydramine

2026-03-20T21:02:59Z

Add MedicationDose entries for benztropine and diphenhydramine

@@ Line 109: / Line 109: @@
 **[[Benztropine]]: 1-2mg PO BID during 2-3 days
 **[[Diphenhydramine]]: 25mg PO QID for 24-72 hours
 ==See Also==

Rossdonaldson1 at 20:07, 12 May 2022

2022-05-12T20:07:26Z

← Older revision		Revision as of 20:07, 12 May 2022
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	*History of EtOH or drug use		*History of EtOH or drug use
	*Associated with administration of [[antiemetics]] or [[antipsychotic]] medications (in 10-60% of treated patients)		*Associated with administration of [[antiemetics]] or [[antipsychotic]] medications (in 10-60% of treated patients)
	*25% of patients treated with [[~~Haldol~~]] have been known to develop this reaction		*25% of patients treated with [[haloperidol]] have been known to develop this reaction
	*Reaction usually occurs within 48 hrs of drug treatment but can occur up to 5 days after starting therapy		*Reaction usually occurs within 48 hrs of drug treatment but can occur up to 5 days after starting therapy
	*Severity and onset of reaction depends on an individual, no association with dose, drug type, potency of drug, or duration of treatment		*Severity and onset of reaction depends on an individual, no association with dose, drug type, potency of drug, or duration of treatment
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	*Stop the offending agent (if antipsychotic, speak with patients psychiatrist before just stopping the medication)		*Stop the offending agent (if antipsychotic, speak with patients psychiatrist before just stopping the medication)
	*Continue to treat with PO anticholinergic to prevent relapse of symptoms (if the culprit is long acting)		*Continue to treat with PO anticholinergic to prevent relapse of symptoms (if the culprit is long acting)
	**Benztropine: 1-2mg PO BID during 2-3 days		**[[Benztropine]]: 1-2mg PO BID during 2-3 days
	**Diphenhydramine: 25mg PO QID for 24-72 hours		**[[Diphenhydramine]]: 25mg PO QID for 24-72 hours

	==See Also==		==See Also==

Beren85: /* Background */

2022-05-05T16:41:51Z

Background

← Older revision		Revision as of 16:41, 5 May 2022
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	*Rarely life threatening but patient is in distress from pain and discomfort		*Rarely life threatening but patient is in distress from pain and discomfort
	*Men > Women		*Men > Women
			*Dystonia is idiosyncratic (not dose-related)

	===Predisposing Factors===		===Predisposing Factors===

Beren85: /* Predisposing Factors */

2022-05-05T16:40:51Z

Predisposing Factors

← Older revision		Revision as of 16:40, 5 May 2022
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	*Family history of dystonic reaction		*Family history of dystonic reaction
	*History of EtOH or drug use		*History of EtOH or drug use
	*Associated with administration of [[antiemetics]] or [[antipsychotic]] medications		*Associated with administration of [[antiemetics]] or [[antipsychotic]] medications (in 10-60% of treated patients)
	*25% of patients treated with [[Haldol]] have been known to develop this reaction		*25% of patients treated with [[Haldol]] have been known to develop this reaction
	*Reaction usually occurs within 48 hrs of drug treatment but can occur up to 5 days after starting therapy		*Reaction usually occurs within 48 hrs of drug treatment but can occur up to 5 days after starting therapy
	*Severity and onset of reaction depends on an individual, no association with dose, drug type, potency of drug, or duration of treatment		*Severity and onset of reaction depends on an individual, no association with dose, drug type, potency of drug, or duration of treatment

	===Medications Associated with Dystonic Reaction===		===Medications Associated with Dystonic Reaction===

Beren85: /* Disposition */

2022-05-05T16:39:22Z

Disposition

← Older revision		Revision as of 16:39, 5 May 2022
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	==Disposition==		==Disposition==
	*Stop the offending agent (if antipsychotic, speak with patients psychiatrist before just stopping the medication)		*Stop the offending agent (if antipsychotic, speak with patients psychiatrist before just stopping the medication)
	*Continue to treat with PO anticholinergic to prevent relapse of symptoms		*Continue to treat with PO anticholinergic to prevent relapse of symptoms (if the culprit is long acting)
	**~~Diphenhydramine~~: ~~12.5~~-~~50mg~~ PO ~~TID~~-~~QID~~		**Benztropine: 1-2mg PO BID during 2-3 days
	**~~Benztropine~~: 1-~~2mg PO BID~~		**Diphenhydramine: 25mg PO QID for 24-72 hours

	==See Also==		==See Also==

Beren85: /* Management */

2022-05-05T16:37:26Z

Management

← Older revision		Revision as of 16:37, 5 May 2022
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	==Management==		==Management==
	*[[Anticholinergic]] medication:		*[[Anticholinergic]] medication:
	**[[Diphenhydramine]]: 50-100mg over 2 minutes
	**[[Benztropine]]: 1-2mg in adults over 2 minutes		**[[Benztropine]]: 1-2mg in adults over 2 minutes
			**[[Diphenhydramine]]: 25-50mg over 2 minutes
	**[[Biperiden]]		**[[Biperiden]]
	**[[Trihexyphenidyl]] 2mg PO BID		**[[Trihexyphenidyl]] 2mg PO BID
	**IV > IM > PO		**IV > IM > PO
	**Symptoms will typically begin resolving in 2-15 minutes but may take up to 90 minutes to completely abate (depends on route in which medication was given)		**Symptoms will typically begin resolving in 2-15 minutes but may take up to 90 minutes to completely abate (depends on route in which medication was given)
	**Patients may require more than one dose of IV medication before symptoms resolve completely		**Patients may require more than one dose of IV medication before symptoms resolve completely
	*[[Benzodiazepines]]		*[[Benzodiazepines]]
	*Airway Management		*Airway Management
	**Rare, but may be indicated in patients with severe respiratory distress from laryngeal or pharyngeal ~~dystoni~~		**Rare, but may be indicated in patients with severe respiratory distress from laryngeal or pharyngeal dystonia

	==Disposition==		==Disposition==

Beren85: /* Evaluation */

2022-05-05T16:33:43Z

Evaluation

← Older revision		Revision as of 16:33, 5 May 2022
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	*Normally a clinical diagnosis		*Normally a clinical diagnosis
	*Consider [[urine toxicology]] if no offending agent given by history		*Consider [[urine toxicology]] if no offending agent given by history
			*More chronic neurologic side effects of phenothiazines (akathisia, tardive dyskinesia, parkinsonism) don't usually respond as dramatically to treatment as does acute dystonia

	==Management==		==Management==

Beren85: /* Clinical Features */

2022-05-05T16:31:42Z

Clinical Features

← Older revision		Revision as of 16:31, 5 May 2022
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	*History of recent drug exposure or increase in drug dosage (e.g. prescription, over the counter, herbals, illegal)		*History of recent drug exposure or increase in drug dosage (e.g. prescription, over the counter, herbals, illegal)
	*Dystonia of any striated muscle group:		*Dystonia of any striated muscle group:
	**[[Torticollar reaction]]		**[[Torticollar reaction]] -> twisted neck or facial muscle spasm
	**Buccolingual reaction		**Buccolingual reaction -> protruding or pulling sensation of the tongue
	**Oculogyric crisis		**Oculogyric crisis -> roving or deviated gaze
	**Promandibular dystonia		**Promandibular dystonia
	**Lingual dystonia		**Lingual dystonia
			**Opisthotonic -> severe hyperextension of entire spinal column
	**Kyphosis/lordosis/scoliosis		**Kyphosis/lordosis/scoliosis
	**Trismus		**Trismus
	**Facial grimacing		**Facial grimacing
	**Tortipelvic crisis		**Tortipelvic crisis -> abdominal rigidity and pain

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Differential Diagnosis */

2020-11-14T13:38:09Z

Differential Diagnosis

← Older revision		Revision as of 13:38, 14 November 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
			{{Movement disorder DDX}}
	{{Jaw spasms DDX}}		{{Jaw spasms DDX}}
	{{Neck pain DDX}}		{{Neck pain DDX}}