{"title":"Delayed-Onset Cariprazine-Induced Akathisia: A Case Report.","authors":"Zachary Goodrich, Drew Grehan","doi":"10.1097/WNF.0000000000000676","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This case report describes the clinically underrecognized manifestation of delayed-onset akathisia induced by cariprazine occurring 10 weeks after treatment initiation. The secondary objective was to discuss potential pharmacokinetic and pharmacodynamic mechanisms of the drug-induced side effects.</p><p><strong>Methods: </strong>A retrospective review of the patient's medical and psychiatric history was performed in addition to a comprehensive literature review.</p><p><strong>Results: </strong>A 42-year-old female with bipolar disorder and generalized anxiety disorder presented to the emergency department on 3 separate occasions with severe restlessness and insomnia, commonly attributed to her previous history of anxiety. Although initial treatment with lorazepam provided subjective symptom relief, the underlying cause persisted. Psychiatry consultation led to a diagnosis of antipsychotic-induced akathisia and administration of diphenhydramine resulted in rapid improvement. The offending agent, cariprazine, was discontinued, resulting in sustained symptom resolution.</p><p><strong>Conclusions: </strong>This case highlights the challenge of distinguishing akathisia from primary anxiety disorders, in addition to considering this diagnosis beyond the initial treatment period. Akathisia symptoms most commonly present within 4 weeks of initiation or titration of antidopaminergic treatment. However, this timeline may be delayed with cariprazine due to its pharmacokinetic and pharmacodynamic properties.</p>","PeriodicalId":10449,"journal":{"name":"Clinical Neuropharmacology","volume":" ","pages":"114-118"},"PeriodicalIF":1.2000,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neuropharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/WNF.0000000000000676","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/3/2 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: This case report describes the clinically underrecognized manifestation of delayed-onset akathisia induced by cariprazine occurring 10 weeks after treatment initiation. The secondary objective was to discuss potential pharmacokinetic and pharmacodynamic mechanisms of the drug-induced side effects.
Methods: A retrospective review of the patient's medical and psychiatric history was performed in addition to a comprehensive literature review.
Results: A 42-year-old female with bipolar disorder and generalized anxiety disorder presented to the emergency department on 3 separate occasions with severe restlessness and insomnia, commonly attributed to her previous history of anxiety. Although initial treatment with lorazepam provided subjective symptom relief, the underlying cause persisted. Psychiatry consultation led to a diagnosis of antipsychotic-induced akathisia and administration of diphenhydramine resulted in rapid improvement. The offending agent, cariprazine, was discontinued, resulting in sustained symptom resolution.
Conclusions: This case highlights the challenge of distinguishing akathisia from primary anxiety disorders, in addition to considering this diagnosis beyond the initial treatment period. Akathisia symptoms most commonly present within 4 weeks of initiation or titration of antidopaminergic treatment. However, this timeline may be delayed with cariprazine due to its pharmacokinetic and pharmacodynamic properties.
期刊介绍：
Clinical Neuropharmacology is a peer-reviewed journal devoted to the pharmacology of the nervous system in its broadest sense. Coverage ranges from such basic aspects as mechanisms of action, structure-activity relationships, and drug metabolism and pharmacokinetics, to practical clinical problems such as drug interactions, drug toxicity, and therapy for specific syndromes and symptoms. The journal publishes original articles and brief reports, invited and submitted reviews, and letters to the editor. A regular feature is the Patient Management Series: in-depth case presentations with clinical questions and answers.
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