Pharmacology · Antiepileptics and CNS Drugs (Antipsychotics, Antidepressants, Sedatives)

A 25-year-old man with acute psychosis is given haloperidol. He develops acute dystonia with torticollis and oculogyric crisis. The most appropriate immediate management is administration of an anticholinergic agent. Which of the following is the drug of choice?

  • A Propranolol
  • B Lorazepam
  • C Benzatropine
  • D Amantadine
Correct answer: C. Benzatropine

Explanation

Acute dystonia from antipsychotics results from dopamine D2 blockade in the nigrostriatal pathway, causing relative cholinergic excess. Benzatropine, a centrally acting anticholinergic, rapidly reverses the spasm when given intramuscularly. Propranolol and lorazepam are not first-line for acute dystonia.

Reference: Katzung & Trevor's Pharmacology Examination and Board Review, 13th ed.

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