Liverpool Hospital Emergency Department
- Acute dystonic reaction – extrapyramidal: this is generally a side effect of medications received – e.g. antipsychotics, metoclopramide (usually within hrs or up to 5 days of starting)
- Injectable 1mg/ml – (2ml ampoule)
- Tablet form – 2mg PO
Dosage and Administration
- Adult – 1-2mg IV – slow IV injection – if no IV IM (takes longer).
- Paediatric – 0.02mg/kg to max 1mg IV.
- Usually responds within 5-20mins – if persists can give second dose.
- 2mg bd as necessary (given to take home if symptoms return)
Anticholinergic side effects
- Dry mouth
- blurred vision
- urinary retention
- Remember good supportive care for acute dystonic reaction
- May need airway support
- May need benzos – e.g. midazolam 1-2mg IV/IM
- If no benztropine – Can try promethazine
Caution if on other meds with anticholinergic effects