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Delayed-Onset Cariprazine-Induced Akathisia: A Case Report
Zachary Goodrich1, Drew Grehan2
1Macon and Joan Brock Virginia Health Sciences Eastern Virginia Medical School at Old Dominion University, Norfolk, VA.
Clinical Neuropharmacology
|March 10, 2026
Summary
Delayed-onset akathisia, a rare side effect of cariprazine, can mimic anxiety. This case report emphasizes considering akathisia beyond the typical 4-week window, especially with cariprazine antipsychotic treatment.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Case Study
Background:
- Akathisia is a common extrapyramidal side effect of antipsychotics.
- Distinguishing akathisia from primary anxiety disorders can be challenging.
- Cariprazine is an atypical antipsychotic used for bipolar disorder and schizophrenia.
Purpose of the Study:
- To report a case of delayed-onset akathisia induced by cariprazine.
- To discuss potential pharmacokinetic and pharmacodynamic mechanisms.
- To highlight the diagnostic challenges and extended timeline for cariprazine-induced akathisia.
Main Methods:
- Retrospective review of patient's medical and psychiatric history.
- Comprehensive literature review on antipsychotic-induced akathisia.
- Case presentation of a patient with bipolar disorder and generalized anxiety disorder.
Main Results:
- A 42-year-old female developed severe restlessness and insomnia 10 weeks after initiating cariprazine.
- Symptoms were initially misattributed to anxiety.
- Diagnosis of antipsychotic-induced akathisia confirmed after psychiatric consultation.
- Diphenhydramine administration led to rapid symptom improvement.
- Discontinuation of cariprazine resulted in sustained symptom resolution.
Conclusions:
- Delayed-onset akathisia is a clinically underrecognized manifestation of cariprazine.
- Akathisia should be considered beyond the typical 4-week onset period, especially with cariprazine.
- Cariprazine's unique pharmacokinetic and pharmacodynamic properties may contribute to delayed akathisia onset.
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