A patient is arching his back and rolling his eyes upward after recently being prescribed Compazine. How should you treat this reaction?

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Multiple Choice

A patient is arching his back and rolling his eyes upward after recently being prescribed Compazine. How should you treat this reaction?

This is an acute extrapyramidal (dystonic) reaction from prochlorperazine, a dopamine blocker. When dopamine in the nigrostriatal pathway is inhibited, acetylcholine dominance in that motor circuit causes involuntary muscle contractions, often presenting as arching of the back and oculogyric (eyes rolled upward). The correct treatment is an anticholinergic drug given quickly, to rebalance the neurotransmitter activity. Diphenhydramine has strong anticholinergic properties and rapidly reverses dystonia when given IV. A typical EMS dose is 25 mg IV push, which acts fast to relieve the cramps and abnormal posturing. Higher doses, like 50 mg, can be used if symptoms persist. Using haloperidol would worsen the dystonia because it’s another dopamine blocker. Benztropine is an alternative anticholinergic, but the prompt’s best-supported option is diphenhydramine 25 mg IVP.

This is an acute extrapyramidal (dystonic) reaction from prochlorperazine, a dopamine blocker. When dopamine in the nigrostriatal pathway is inhibited, acetylcholine dominance in that motor circuit causes involuntary muscle contractions, often presenting as arching of the back and oculogyric (eyes rolled upward).

The correct treatment is an anticholinergic drug given quickly, to rebalance the neurotransmitter activity. Diphenhydramine has strong anticholinergic properties and rapidly reverses dystonia when given IV. A typical EMS dose is 25 mg IV push, which acts fast to relieve the cramps and abnormal posturing. Higher doses, like 50 mg, can be used if symptoms persist. Using haloperidol would worsen the dystonia because it’s another dopamine blocker. Benztropine is an alternative anticholinergic, but the prompt’s best-supported option is diphenhydramine 25 mg IVP.

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