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

Abstract

, Abstract-Background: Although first-generation antipsychotics (FGAs) have long been used in the emergency department (ED) to treat acute agitation, little is known about how these medications are used in modern clinical practice. In particular, little work has been published about whether ED clinicians administer FGAs with adjunctive medications in accordance with expert guidelines or the prescribing practices of FGAs over time. Objectives: 1) To provide a comparison of the frequency with which FGAs are administered with adjunctive benzodiazepines or anticholinergic medications. 2) To analyze the prescribing trends for FGAs over time, particularly in the years after the U.S. Food and Drug Administration (FDA) black-box warning for droperidol. Methods: This is a structured review of a retrospective cohort of patients receiving haloperidol or droperidol in two EDs over a 7-year period. Results: Haloperidol or droperidol was administered on 2833 patient visits during the study period, with haloperidol being administered most often. Adjunctive medications are administered less than half of the time. The use of droperidol has remained relatively static, whereas the use of haloperidol has increased. Conclusions: First-generation antipsychotics are still widely utilized in the ED. When administered, these medications are used with adjunctive medications that may decrease side effects less than half of the time. Droperidol use has remained unchanged in the years after the FDA black-box warning, whereas use of haloperidol has continued to rise. Ó 2015 Elsevier Inc.

Determination of combination therapy prescribing patterns for the treatment of acute agitation in psychiatric patients: A regression model of patient diagnoses and demographics

“…To our knowledge, this is the first study to create a statistical model that connects demographics and diagnoses to prescribing patterns for acute agitation in practice. Compared to previous studies11,12 assessing acute agitation treatment in the emergency department, this study showed a higher rate of combination therapy prescribing. Our study found several factors that have a significant association with the prescribing of combination therapy for acute agitation.…”

“…Previous retrospective studies11,12 have been completed that assess the prescribing patterns of physicians in the emergency department when treating acute agitation. However, there is insufficient data on the prescribing patterns regarding combination therapy in psychiatric units specifically, and prediction models are lacking.…”

Oral Medication for Agitation of Psychiatric Origin: A Scoping Review of Randomized Controlled Trials

“…Over the past several years, expert consensus panels, most recently Project BETA, have called for improved humane practices to treat agitated patients [3]. Project BETA ("Best Evidence for the Evaluation and Treatment of Agitation") convened over 35 experts, including emergency psychiatrists, emergency medicine physicians, and mental health clinicians, preferentially recommending second-generation antipsychotics (SGAs) over the more common combination of intramuscular haloperidol + lorazepam [4][5][6][7]. SGAs were preferentially recommended orally, both to save patients the unpleasantness of needle sticks and to potentially save injury to nursing staff but the recommendation relied mostly on expert consensus instead of a comprehensive survey of available literature [8].…”

Ketamine Use for Acute Agitation in the Emergency Department

“…Emergency physicians regularly encounter agitated patients in the emergency department (ED) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Causes of ED-based agitation are numerous, ranging from psychosis to intoxication (2)(3)(4)(5)8).…”