Oculogyric crisis is most commonly associated with which drug class?

• A. Phenothiazines
• B. Beta blockers
• C. Opioids
• D. Anticholinesterases

Answer: (A)

Oculogyric crisis is an acute dystonic reaction caused by disruption of the dopaminergic–cholinergic balance in the basal ganglia due to dopamine D2 receptor blockade. Phenothiazines, a class of typical antipsychotics, are classic offenders because they strongly antagonize D2 receptors in the nigrostriatal pathway. This leads to sustained, involuntary contractions of extraocular muscles with an upward gaze, often occurring soon after starting or increasing the dose. The reaction is typically reversible with anticholinergic treatment (like benztropine or diphenhydramine) or by adjusting the antipsychotic regimen. Other drug classes listed do not usually produce this acute dystonic pattern.