Akathisia is a frequent and distressing side effect of neuroleptic medications. The literature regarding the pharmacologic treatment of acute neuroleptic-induced akathisia is critically reviewed, including nine reports of the use of anticholinergic agents, 15 of the use of beta-blocking agents, and six of the use of benzodiazepines. Reports of trials on clonidine, amantadine, piracetam, and of a patient treated with amitriptyline are also discussed. Tentative recommendations for the management of acute akathisia are proposed.