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

Wilson, Michael P.; MacDonald, Kai; Vilke, Gary M.; Feifel, David

doi:10.1016/j.jemermed.2010.04.012

Cited by 35 publications

(22 citation statements)

References 15 publications

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“…For example, in a recent retrospective chart review in our ED, we found that benzodiazepines were administered concomitantly with i.m. olanzapine 40% of the time (15). This study found no adverse effects on blood pressure, heart rate, or oxygen saturation with this combination in patients who were not intoxicated with ethanol (EtOH), but did find evidence of greater reductions in oxygen saturations (but not blood pressure or heart rate) in patients who were intoxicated with alcohol and who then received this combination of medications (16).…”

Section: Introductionmentioning

confidence: 65%

“…ziprasidone, were documentation in the chart of blood pressure, heart rate, and oxygen saturations before medication administration and within 4 h afterwards. Although the half-life of ziprasidone has been noted to be approximately 7 h, the 4-h window has been standard for other investigations of this type (1,15,16). Patients who received multiple doses of ziprasidone were only entered in the analysis once for the first dose of the medication, but could be entered in the analysis more than once if they made more than one visit.…”

Section: Methodsmentioning

confidence: 99%

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

Wilson¹,

MacDonald²,

Vilke³

et al. 2013

The Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

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

Wilson¹,

MacDonald²,

Vilke³

et al. 2013

The Journal of Emergency Medicine

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“…Although the D2 receptor, and in particular, the dopamine system, is not the only neurotransmitter implicated in psychosis, interruption of dopamine transmission nonetheless relieves psychotic symptoms in agitated patients (8)(9)(10)(11). Given this, FGAs such as haloperidol and droperidol have a long tradition of use in the ED, and may be safer than some second-generation antipsychotics in alcoholpositive patients (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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

Campillo¹,

Castillo

Vilke

et al. 2015

The Journal of Emergency Medicine

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, 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.

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“…Additional calming medication was defined as additional antipsychotics, benzodiazepines, or ketamine administered for agitation within 3 h of the initial dose of ketamine. Although 3 h is not based on the half-life of ketamine, this figure has been used in other agitation investigations of this type (26)(27)(28)(29). All records were evaluated by a minimum of three researchers who were trained on use of the EMR.…”

Section: Selection Of Participantsmentioning

confidence: 99%

“…Change in vital signs within 4 h after administration of ketamine was calculated relative to the baseline vital sign preadministration within each patient to prevent small changes in baseline vital signs from skewing the analysis across patients. Four hours postmedication administration was chosen, as this has been used in other investigations of this type and is approximately equal to two half-lives of ketamine (t1/2 = 2.17 h) (23,(26)(27)(28)(29). Hypoxia after administration of ketamine was defined as an oxygen saturation of <90%.…”

Section: Data Collection and Processingmentioning

confidence: 99%

Ketamine Use for Acute Agitation in the Emergency Department

Hopper

Vilke

Castillo

et al. 2015

The Journal of Emergency Medicine

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, Abstract-Background: Emergency physicians regularly encounter agitated patients. In extremely agitated and violent patients, the onset of many traditional medications is relatively slow and often requires additional medication. Ketamine is frequently used in emergency departments (EDs) for procedural sedation and intubation, but has recently been suggested as a treatment for acute agitation. Objectives: We sought to examine the use of ketamine in the treatment of acute agitation in an ED setting, including vital sign changes as a result of this medication. Methods: This is a structured review of an historical cohort of patients over 7 years at two university EDs. Patients were included if they received ketamine as treatment for acute agitation. Abstracted data included age, vital signs including hypoxia, any additional medications for agitation, and alcohol/drug intoxication. Results: Ketamine was administered for agitation on 32 visits involving 27 patients. Preadministration systolic blood pressure was 131 ± 20 mm Hg, with an average postadministration increase of 17 ± 25 mm Hg. The average baseline heart rate was 98 ± 23 beats/min, with an average increase of 8 ± 17 beats/min. No patients became hypoxic; 62.5% of patients required additional calming medication. Alcohol or drug intoxication was present in 40.6% of patients. Conclusions: We found ketamine was used rarely, but had few major adverse effects on vital signs even in a population with 21.9% alcohol intoxication. However, a high proportion (62.5%) of patients required additional pharmacologic treatment for agitation, implying that administering ketamine is useful only for initial control of severe agitation. Ó 2015 Elsevier Inc.

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

Cited by 35 publications

References 15 publications

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

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

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

Ketamine Use for Acute Agitation in the Emergency Department

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