How is an acute dystonic reaction treated?

• A. Administer an anticholinergic such as benztropine or diphenhydramine and stop triggering medication
• B. Administer benzodiazepines only
• C. Increase the triggering medication
• D. Hydration only

Answer: (A)

Acute dystonic reactions occur when blocking dopamine in the nigrostriatal pathway shifts the balance toward acetylcholine in the basal ganglia, producing painful muscle contractions and abnormal postures. The best treatment is a rapid-acting anticholinergic, such as benztropine, or the antihistaminergic anticholinergic diphenhydramine, given by injection to quickly reverse the symptoms. At the same time, stop the offending medication to prevent recurrence. Benzodiazepines can help with agitation or provide some relief, but they don’t reliably reverse the dystonia on their own. Hydration alone doesn’t address the motor symptoms, and increasing the triggering drug would worsen the reaction.