OBJECTIVE Beta-blocking agents, particularly propranolol, are considered effective in the treatment of neuroleptic-induced akathisia, but considerable controversy exists about the involved receptor subtype(s). The authors conducted a randomized, controlled trial comparing the effects of propranolol and betaxolol to determine whether central beta 1-adrenoceptor blockade is sufficient to correct neuroleptic-induced akathisia. METHODS The subjects were 19 patients whose neuroleptic-induced akathisia responded to 20 mg/day of propranolol and subsequently reemerged during a placebo washout period. They were randomly assigned to propranolol (20 or 40 mg/day) or betaxolol (10 or 20 mg/day) and, after another placebo period, were switched to the second beta blocker. RESULTS There was no significant difference in the antiakathisia effects of propranolol and betaxolol. CONCLUSIONS The lack of difference between propranolol and betaxolol suggests that beta 1-adrenoceptor blockade is sufficient to improve neuroleptic-induced akathisia. The results of this explanatory study need therapeutic confirmation.