DISCUSSION Nocturnal akathisia may develop after acute neuroleptic treatment. Clozapine mainly acts on D1, D3, and D4 receptors along with an antagonistic action on 5HT and a-1 adrenoceptors. 14 Although clozapine was being administered on a twice-daily dosage, the delayed onset of akathisia, especially during the night only, occurred. This may have resulted from a pharmacodynamic effect through serotonin-dopamine and a-receptor interaction. The appearance of acute akathisia on an antipsychotic has been reported to predict poor response to the drug. 3 However, our patient’s schizophrenia improved on clozapine despite the appearance of akathisia. This report also shows that short-term propranolol treatment may be effective in the management of clozapine-induced acute nocturnal akathisia and suggests the need for controlled studies to further analyze this effect.