Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine

Raveendran, Nirmal S; Tharyan, Prathap; Alexander, Jacob; Adams, Clive E

doi:10.1136/bmj.39341.608519.be

Cited by 99 publications

(106 citation statements)

References 31 publications

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“…Because of the strength of evidence for efficacy in alleviating agitation in this population, aripiprazole IM (level 2),125, 126 lorazepam IM (level 2),125, 127 loxapine inhaled (Level 1)128, 129 and olanzapine IM (level 2)127, 130, 131, 132, 133 are recommended as the first‐line option. Sublingual asenapine (level 3),134 haloperidol IM (level 3),131, 135, 136 haloperidol IM + midazolam IM (level 3),131, 137 haloperidol IM + promethazine IM (level 3),131, 137, 138 risperidone ODT (level 3),136 and ziprasidone IM (level 3)131, 137, 139 are recommended as a second‐line treatment. Haloperidol per os (PO) (level 4),140, 141 loxapine IM (level 4) (clinical opinion), quetiapine PO (level 4),141 and risperidone PO (level 4)140 are included as third‐line options (Table 11).…”

Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Acute Management Of Bipolar Maniamentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…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).…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

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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“…22 Concerning side-effects, no significant differences were observed between the promethazine-haloperidol association and olanzapine, 21 but dystonia was more frequent in patients medicated with haloperidol alone. 22 At any rate, the available data indicate a primarily sedative effect of promethazine.…”

mentioning

confidence: 99%

“…Currently available evidence suggests that the sedative effects of the association of promethazine and haloperidol could be stronger than those obtained with the use of olanzapine 21 or haloperidol alone. 22 Concerning side-effects, no significant differences were observed between the promethazine-haloperidol association and olanzapine, 21 but dystonia was more frequent in patients medicated with haloperidol alone.…”

mentioning

confidence: 99%

Manejo de paciente agitado ou agressivo

Mantovani

Migon

Alheira

et al. 2010

Rev. Bras. Psiquiatr.

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Objective: To review current data concerning the management of agitated or aggressive patients. Method: A search was performed in the PubMed and Web of Science databases and empirical articles and reviews about pharmacological and non-pharmacological interventions for the management of agitation and/or violence were selected and analyzed. Results: The non-pharmacological management of agitation/aggression involves the physical organization of the emergency department and the adequacy of the behavior and attitudes of health professionals. The main goal of pharmacological management is rapid tranquilization, aimed at reducing symptoms of agitation and aggression without inducing deep or prolonged sedation, keeping the patient calm but fully or partially responsive. Polypharmacy should be avoided and medication doses should be as low as possible, adjusted according to clinical requirements. Intramuscular administration of drugs should be considered as a last option. Available options related to the use of antipsychotics and benzodiazepines are described and discussed. The physical management by means of mechanical restraint may be necessary in violent situations involving risks for the patient or staff and must be performed according to strict criteria. Conclusion: Procedures must be carefully implemented to avoid physical and emotional complications for patients and staff. Descriptors

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Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine

Cited by 99 publications

References 31 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

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

Manejo de paciente agitado ou agressivo

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