Which medications are commonly used to treat extrapyramidal symptoms?

• A. ACE inhibitors
• B. Antibiotics
• C. Anticoagulants
• D. Benzodiazepines and diphenhydramine

Answer: (D)

Extrapyramidal symptoms come from antipsychotic dopamine blockade in the brain, leading to movement issues like dystonia, restlessness (akathisia), stiffness (parkinsonism), or abnormal mouth and facial movements (tardive dyskinesia). Treating these symptoms targets reducing the relative excess of acetylcholine that results when dopamine signaling is blocked. Diphenhydramine works well here because it’s an antihistamine with strong anticholinergic effects, helping to rapidly relieve dystonic reactions and other EPS. Benzodiazepines add another option by providing muscle relaxation and calming effects, which can ease akathisia and related discomfort. Using these together addresses the different ways EPS can present and is a common approach in management. Medications like ACE inhibitors, antibiotics, or anticoagulants don’t impact the dopaminergic-cholinergic imbalance causing EPS, so they aren’t used for this purpose.