Treating Akathisia: Midazolam vs. Diphenhydramine

Akathisia, an uncomfortable mental and physical restlessness, is a known side effect of antiemetics, such as metoclopramide; it is often treated with diphenhydramine. In a randomized, double-blind trial, researchers in Turkey compared the efficacy of midazolam (2 mg intravenously) with that of diphenhydramine (20 mg IV) for treating akathisia in 56 adult patients who received metoclopramide for vascular headache or nausea and vomiting.

The Prince Henry Hospital Rating Scale of Akathisia was used to measure objective, subjective, and total akathisia scores, and the modified Ramsay Sedation Scale was used to measure level of sedation. At baseline, akathisia scores were significantly higher in the group randomized to midazolam.

Midazolam caused …