Pharmacological Management of Acute Agitation

  title={Pharmacological Management of Acute Agitation},
  author={John Battaglia},
Acute agitation occurs in a variety of medical and psychiatric conditions, and when severe can result in behavioural dyscontrol. Rapid tranquillisation is the assertive use of medication to calm severely agitated patients quickly, decrease dangerous behaviour and allow treatment of the underlying condition. Intramuscular injections of typical antipsychotics and benzodiazepines, given alone or in combination, have been the treatment of choice over the past few decades.Haloperidol and lorazepam… 

Safety and effectiveness of drug therapy for the acutely agitated patient (Part 2)

In patients with primary psychiatric disease, the second-generation atypical antipsychotics, mainly risperidone and olanzapine, were shown to be at least as effective, and possibly safer, than traditional agents.

Ultra-Rapid, Unexpected, and Full Remission of Manic Episode afterTreatment with Haloperidol High Doses 2 Case Reports

Two cases of unusual, unexpected, ultrafast and full remission of a manic episode after treatment with haloperidol high doses are presented.

Treatment of Agitation With Lorazepam in Clinical Practice: A Systematic Review

Based on this structured review, lorazepam can be considered to be a clinically effective means of treating the acutely agitated patient.

Pharmacologic Management of Acutely Agitated Pediatric Patients

Compared with typical antipsychotic drugs, atypical antipsychotics have a more favorable short-term side effect profile and are more likely to cause adverse neurologic effects.

Safety and efficacy of pharmacologic agents used for rapid tranquilization of emergency department patients with acute agitation or excited delirium

Using antipsychotics and benzodiazepines – whether a single agent or combined – will have similar efficacy in producing sedation, but there are differences in the time to sedation depending on which agent is used.

Challenges in the Pharmacologic Management of Agitation

There are significant unmet needs for novel antiagitation treatments that are rapid in onset, accepted by patients and staff, less invasive (as compared with intramuscular or intravenous formulations), and easy and safe to administer.

Clinical Challenges in the Pharmacologic Management of Agitation

There are significant unmet needs for novel antiagitation treatments that are rapid in onset, accepted by patients and staff, less invasive (as compared with intramuscular or intravenous formulations), and easy and safe to administer.

Management of Acute Agitation in the Emergency Department

  • S. Baker
  • Medicine, Psychology
    Advanced emergency nursing journal
  • 2012
Advantages and disadvantages of various treatment modalities for undifferentiated, psychotic, and nonpsychotic agitation are reviewed, including alternatives to the commonly prescribed haloperidol and lorazepam combination.

[Inhaled loxapine: A novel treatment for agitation in psychotic disorders].

  • M. Siwek
  • Medicine, Psychology
    Psychiatria polska
  • 2014
Inhaled loxapine seems to be an effective anti-agitation drug in treatment of patients with schizoplhenia and BD (with the onset of action similar to the one observed in intramuscular antipsychotics), however, this formulation of loxAPine is distinguished by its non-invasive route of administration, as accompanied by markedly, low risk of side effects or adverse events.



Intramuscular ziprasidone: moving beyond the conventional in the treatment of acute agitation in schizophrenia.

  • S. Brook
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2003
In patients with acute psychosis, with or without agitation, IM ziprasidone has been demonstrated to be superior to IM haloperidol in improving overall symptom severity and represents an important advance over older, conventional IM agents in the treatment of the acutely ill patient with schizophrenia.

Rapid parenteral treatment of acute psychosis.

Acute treatment of psychotic agitation: a randomized comparison of oral treatment with risperidone and lorazepam versus intramuscular treatment with haloperidol and lorazepam.

A single oral dose of risperidone plus lorazepam was as effective as parenterally administered haloperidol plus lorbizepam for the rapid control of agitation and psychosis.

Long-Acting Antipsychotic Medication, Restraint and Treatment in the Management of Acute Psychosis

  • P. Fitzgerald
  • Medicine, Psychology
    The Australian and New Zealand journal of psychiatry
  • 1999
ZA is the first parenteral antipsychotic medication introduced for clinical use in the treatment of aggression and agitation that has a relatively prolonged duration of action and is a novel and potentially useful treatment alternative in the acutely disturbed patient.

The use of midazolam in acutely agitated psychiatric patients.

Both midazolam and sodium amytal were significantly more effective than haloperidol in controlling motor agitation and there were no treatment differences on any other symptom rated.

Intramuscular ziprasidone, 2 mg versus 10 mg, in the short-term management of agitated psychotic patients.

Comparison with a study of identical design comparing 2-mg with 20-mg doses in patients with similar levels of psychopathology suggests that efficacy with 10 mg or 20 mg of ziprasidone i.m. is significant and dose related.

Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia.

The combination of alprazolam and haloperidol seems to be the most effective for agitated patients, particularly in the first 48 hours of treatment, and may also result in fewer dystonic reactions.

Intramuscular flunitrazepam versus intramuscular haloperidol in the emergency treatment of aggressive psychotic behavior.

Intramuscular flunitrazepam may serve as a convenient, rapid, safe, and effective adjunct to neuroleptics in reducing aggressive behavior in emergency psychiatric settings.

Intramuscular (IM) ziprasidone 20 mg is effective in reducing acute agitation associated with psychosis: a double-blind, randomized trial

Ziprasidone IM 20 mg was substantially and significantly reduced the symptoms of acute agitation in patients with psychotic disorders and was very well tolerated and produced no dystonia or akathisia.

Neuroleptic malignant syndrome.

Data drawn from clinical observations and basic studies support the primary role of an acute reduction in brain dopamine activity in the development of neuroleptic malignant syndrome.