This review suggests that both benzodiazepines work , but that midazolam has a faster onset and thereby reduces the risk of exposure to violence .
Most evidence , however , exists for the haloperidol plus promethazine mix , with currently more than 400 people r and omised to the combination .
The onset of action is swift and faster than lorazepam .
The combination also seems safe with no clear longer term consequences .
BACKGROUND Health services often manage agitated or violent people and for emergency psychiatric services such behaviour is particularly prevalent ( 10 % ) .
The drugs used in this situation should ensure that the person swiftly and safely becomes calm .
OBJECTIVES To examine whether haloperidol plus promethazine is an effective treatment for psychosis induced agitation/aggression .
A double-blind, placebo-controlled dose-response comparison of intramuscular olanzapine and haloperidol in the treatment of acute agitation in schizophrenia.
BACKGROUND An intramuscular ( IM ) formulation of olanzapine has been developed because there are no rapid-acting IM atypical antipsychotic drugs currently available in the United States for treating acute agitation in patients with schizophrenia . METHODS Recently hospitalized acutely agitated patients with schizophrenia ( N = 270 ) were r and omized to receive 1 to 3 IM injections of olanzapine ( 2.5 , 5.0 , 7.5 , or 10.0 mg ) , haloperidol ( 7.5 mg ) , or placebo within 24 hours . A dose-response relationship for IM olanzapine in the reduction of agitation was assessed by measuring the reduction in Positive and Negative Syndrome Scale Excited Component ( PANSS-EC ) scores 2 hours after the first injection . Safety was assessed by recording adverse events and with extrapyramidal symptom scales and electrocardiograms at 24 hours after the first injection . RESULTS Olanzapine exhibited a dose-response relationship for reduction in agitation ( F(1,179)= 14.4 ; P<.001 ) . Mean PANSS-EC reductions 2 hours after the first injection of olanzapine ( 2.5 mg = -5.5 ; 5.0 mg = -8.1 ; 7.5 mg = -8.7 ; 10.0 mg = -9.4 ) were superior to those with placebo ( -2.9 ; P = .01 vs olanzapine at 2.5 mg ; P<.001 for each other olanzapine dose ) but not with haloperidol ( -7.5 ) . A dose of 5.0 , 7.5 , or 10.0 mg of olanzapine caused a greater reduction in agitation than placebo 30 minutes after the first injection . There were no differences between treatment groups for hypotension , the most frequently reported adverse event , or for clinical ly relevant changes in the QTc interval . There was a greater incidence of treatment-emergent parkinsonism during treatment with IM haloperidol ( 16.7 % ) than with 2.5 ( P = .03 ) , 5.0 ( P = .03 ) , or 7.5 mg ( P = .01 ) of IM olanzapine ( 0 % ) or with placebo ( 0 % ) ( P = .01 ) . CONCLUSIONS Intramuscular olanzapine at a dose of 2.5 to 10.0 mg per injection exhibits a dose-response relationship in the rapid treatment of acute agitation in patients with schizophrenia and demonstrates a favorable safety profile
This review suggests that both benzodiazepines work , but that midazolam has a faster onset and thereby reduces the risk of exposure to violence .
Most evidence , however , exists for the haloperidol plus promethazine mix , with currently more than 400 people r and omised to the combination .
The onset of action is swift and faster than lorazepam .
The combination also seems safe with no clear longer term consequences .
BACKGROUND Health services often manage agitated or violent people and for emergency psychiatric services such behaviour is particularly prevalent ( 10 % ) .
The drugs used in this situation should ensure that the person swiftly and safely becomes calm .
OBJECTIVES To examine whether haloperidol plus promethazine is an effective treatment for psychosis induced agitation/aggression .