They can also use gabapentin if for some reason propanolol or cogentin can't be used. I actually combined a manic episode with akathesia and landed IP and couldn't have propranolol (maybe my MAOI? I can't remember). I also can't remember if I had cogentin but I think I did. But I did definitely have gabapentin which they said was the 2nd line of defense. The problem was I needed so much (and in combination with more AP for the mania) that I was really sedated. However I was able to lower the gabapentin fairly soon and the akathesia went away. In that case it wasn't from my psych meds but from something given during anesthesia.

Never, ever combine mania and akathesia. I wound up with 1:1 in the hospital for a couple days because I was so agitated and the aide was supposed to help me stay calm with crafts and "can you help us sort these markers?" and the like. I know I made my fellow patients want to hide when I was coming.