A 22-year-old man started on haloperidol 10 mg/day three days ago develops sudden painful torticollis with upward deviation of the eyes. He is alert and afebrile. What is the most appropriate immediate treatment?

• A Reassurance, as the reaction resolves spontaneously over months
• B Stop haloperidol and start levodopa
• C Intravenous dantrolene
• D Intramuscular promethazine or benztropine ✓

Explanation

This is an acute dystonic reaction, the earliest extrapyramidal side effect of high-potency antipsychotics, typically appearing within the first week. It responds rapidly to parenteral anticholinergics such as benztropine or antihistaminics such as promethazine. Dantrolene is the specific treatment for neuroleptic malignant syndrome, which this febrile-free, alert presentation excludes, and spontaneous resolution takes hours to days, not months, so reassurance alone is inadequate.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.