Beware of the problems of abrupt withdrawal of long term benzos, particularly if short acting - fits, confusion, tremors etc. Benzos have NO analgesic effect and concurrent analgesics need to be continued even in a semicomatose or comatose patient. For the more severely disturbed and confused patient neuroleptics are often needed, sometimes in conjunction with benzos. Also if there is an adverse reaction to benzos neuroleptics may be needed. The following table shows the most commonly used neuroleptics.
Haloperidol is usually effective in targeting agitation, paranoia and fear.
The intravenous route is often more effective and quicker acting than the S.C. route. Haloperidol is also an excellent antiemetic if that is required. However it has more anticholinergic side effects than thioidazine. If more sedation is needed thioidazine or chlorpromazine may be more effective but these agents have more hypotensive side effects. Chlorpromazine can be given by deep IM injection but is irritating to tissues and this may be a particular problem in an emaciated patient.