A Naturalistic Study of Intramuscular Haloperidol Versus Intramuscular Olanzapine for the Management of Acute Agitation

Abstract

Overall, these finding suggest that in a naturalistic emergency department setting, haloperidol monotherapy is less effective--at least in requiring AMI--than olanzapine with or without a benzodiazepine or haloperidol plus a benzodiazepine. Moreover, these later 3 regimens seemed comparable. Prospective studies examining the treatment of real-world agitation, including head-to-head comparisons of the haloperidol-benzodiazepine combination with newer IM antipsychotics, are needed.

Intramuscular Ziprasidone: Influence of Alcohol and Benzodiazepines on Vital Signs in the Emergency Setting

“…The practice is most exemplified by the use of i.m. haloperidol and lorazepam with or without diphenhydramine, which remains the most widely used combination by ED physicians (18). Evidence supporting the combination use of i.m.…”

“…ziprasidone is combined with benzodiazepines or whether this combination affects vital signs in alcohol-intoxicated patients (2,17). This is somewhat surprising because patients who are intoxicated with alcohol are common in the ED setting (14,18,19).…”

Review article: Workplace violence in the emergency department: A systematic review and meta analysis

“…22 This is substantiated by higher rates reported for studies that clinically diagnosed intoxication by breath or blood alcohol analysis and/or urine drug toxicology. 35,37,48 Australian studies paint an inconsistent picture. The study conducted by Brookes and Dunn in 1997 had similar findings to the study by Downes et al completed in 2009 with the number of episodes of violence per 10 000 presentations annually reported to be 55 and 56, respectively.…”

Potential Complications of Combining Intramuscular Olanzapine with Benzodiazepines in Emergency Department Patients

“…To decrease the risk of movement-related side effects and to potentiate calming effects, haloperidol is often used in conjunction with a benzodiazepine such as lorazepam (1,2). However, recent expert guidelines recommend newer, second-generation or "atypical" antipsychotics available in injectable formulations as first-line treatments in many cases, both because second-generation antipsychotics seem to be more effective in many instances and because they have lower risks of movementrelated side effects (3).…”