When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour .
There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects .
Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects .
Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation .
In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome .
OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms .
A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients.
OBJECTIVES To determine if midazolam is superior to lorazepam or haloperidol in the management of  violent and severely agitated patients in the emergency department . Superiority would be determined if midazolam result ed in a significantly shorter time to sedation and shorter time to arousal . METHODS This was a r and omized , prospect i ve , double-blind study of a convenience sample of patients from an urban , county teaching emergency department . Participants included 111 violent and severely agitated patients . Patients were r and omized to receive intramuscular midazolam ( 5 mg ) , lorazepam ( 2 mg ) , or haloperidol ( 5 mg ) . RESULTS The mean ( + /-SD ) age was 40.7 ( + /-13 ) years . The mean ( + /-SD ) time to sedation was 18.3 ( + /-14 ) minutes for patients receiving midazolam , 28.3 ( + /-25 ) minutes for haloperidol , and 32.2 ( + /-20 ) minutes for lorazepam . Midazolam had a significantly shorter time to sedation than lorazepam and haloperidol ( p < 0.05 ) . The mean difference between midazolam and lorazepam was 13.0 minutes ( 95 % confidence interval [ 95 % CI ] = 5.1 to 22.8 minutes ) and that between midazolam and haloperidol was 9.9 minutes ( 95 % CI = 0.5 to 19.3 minutes ) . Time to arousal was 81.9 minutes for patients receiving midazolam , 126.5 minutes for haloperidol , and 217.2 minutes for lorazepam .  Time to arousal for midazolam was significantly shorter than for both haloperidol and lorazepam ( p < 0.05 ) . The mean difference in time to awakening between midazolam and lorazepam was 135.3 minutes ( 95 % CI = 89 to 182 minutes ) and that between midazolam and haloperidol was 44.6 minutes ( 95 % CI = 9 to 80 minutes ) . There was no significant difference over time by repeated- measures analysis of variance between groups in regard to changes in systolic and diastolic blood pressure ( p = 0.8965 , p = 0.9581 ) , heart rate ( p = 0.5517 ) , respiratory rate ( p = 0.8191 ) , and oxygen saturation ( p = 0.8991 ) . CONCLUSIONS Midazolam has a significantly shorter time to onset of sedation and a more rapid time to arousal than lorazepam or haloperidol . The efficacies of all three drugs appear to be similar
When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour .
There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects .
Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects .
Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify .
BACKGROUND Acute psychotic illness , especially when associated with agitated or violent behaviour , can require urgent pharmacological tranquillisation or sedation .
In several countries , clinicians often use benzodiazepines ( either alone or in combination with antipsychotics ) for this outcome .
OBJECTIVES To estimate the effects of benzodiazepines , alone or in combination with antipsychotics , when compared with placebo or antipsychotics , alone or in combination with antihistamines , to control disturbed behaviour and reduce psychotic symptoms .