Clin Psychopharmacol Neurosci 2018; 16(3): 346-348  
Successful Management of Clozapine-induced Akathisia with Gabapentin Enacarbil: A Case Report
Masahiro Takeshima, Hiroyasu Ishikawa, Yuka Kikuchi, Takashi Kanbayashi, Tetsuo Shimizu
Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
Correspondence to: Masahiro Takeshima, MD, PhD
Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita-shi, Akita 010-8543, Japan
Tel: +81-18-884-6122, Fax: +81-18-884-6163
Received: January 2, 2017; Revised: February 23, 2017; Accepted: March 7, 2017; Published online: August 31, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The management of clozapine (CLZ)-induced adverse events affects patient prognoses. Akathisia is a relatively rare adverse event related to CLZ administration and thus the management of this syndrome is not well established. Here, we report a case of treatment-resistant schizophrenia wherein CLZ-induced akathisia was successfully managed with gabapentin enacarbil (GE). The patient was a 39-year-old woman who had been treated with atypical antipsychotics other than CLZ for three years with poor tolerability. Initiation of CLZ (400 mg/day) attenuated her psychotic symptoms, but was followed by moderate akathisia. Neither benzodiazepines nor biperiden improved the akathisia; however, akathisia was finally diminished with co-administration of GE. GE facilitated a dosage increase in CLZ (450 mg/day) for the improved management of pyschotic symptoms, and thus indirectly contributed to treatment of the patient’s schizophrenia. We suggest that GE is a useful candidate for the management of CLZ-induced akathisia. The improved management of treatment-induced akathisia and other adverse events can extend the potential application of CLZ for treatment-resistant schizophrenia.
Keywords: Akathisia, drug induced; Antipsychotic agents; Clozapine; Gabapentin; Gabapentin enacarbil; Restless legs syndrome.

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