Haloperidol plus promethazine for psychosis-induced aggression

Abstract

Trusted evidence. Informed decisions. Better health.

First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications

“…The major findings of this study are that first-generation antipsychotics like haloperidol or droperidol are administered with adjunctive medications such as benzodiazepines, promethazine, benztropine, or diphenhydramine only 49.5% of the time. Although this study was not designed to investigate the beneficial effects of these combinations, it is notable that there is substantial literature that suggests the idea of doing so, specifically in the case of acute psychosis or undifferentiated agitation (9,(28)(29)(30)(31). In contrast to a 2012 Cochrane review, which suggested that 1 in 5 patients developed acute dystonia after administration of haloperidol alone, a second Cochrane review summarizing trials with haloperidol administered with promethazine found that approximately 1 in 15 patients developed some sort of preventable adverse effect after haloperidol alone (18,28).…”

“…Although this study was not designed to investigate the beneficial effects of these combinations, it is notable that there is substantial literature that suggests the idea of doing so, specifically in the case of acute psychosis or undifferentiated agitation (9,(28)(29)(30)(31). In contrast to a 2012 Cochrane review, which suggested that 1 in 5 patients developed acute dystonia after administration of haloperidol alone, a second Cochrane review summarizing trials with haloperidol administered with promethazine found that approximately 1 in 15 patients developed some sort of preventable adverse effect after haloperidol alone (18,28). This review noted that ''haloperidol used on its own is at such risk of generating preventable adverse effects that unless it is the only choice, this evidence directs that this sole treatment should be avoided'' [(28), p. 2].…”

“…This study concluded that calming was more rapid and the incidence of motor-related side effects decreased in patients who received lorazepam in combination with haloperidol compared to haloperidol alone. A similar study involving haloperidol administered with promethazine concluded that this combination was more effective, with fewer side effects than a second-generation antipsychotic like olanzapine (28,29).…”

“…The best evidence for adjunctive medications, studied in the TREC trials, is for promethazine in conjunction with haloperidol (28,29,35). Extrapyramidal side effects in patients receiving droperidol are usually treated in a similar manner, often with an anticholinergic medication such as diphenhydramine or promethazine (32).…”

Psykisk syke mangler rettssikkerhet

“…FGApreparater gitt som injeksjon, medfører stor risiko for akutte nevromuskulaere bivirkninger dersom det ikke samtidig gis antikolinerge antiparkinsonmidler (325). Hos svaert motorisk urolige pasienter brukes noen ganger den motorisk dempende effekten av dopaminblokade for å holde pasienten i ro.…”