agitated patient? Vitamin A (ativan), Vitamin H (haldol), or both?

20 Jan

common practice for agitated patients, but is there evidence for one or the other?

2012 Cochrane Review highlights:

  • Three trials (n = 205) compared haloperidol with lorazepam.
  • no significant differences between the groups with regard to the number of participants asleep at one hour
  • by three hours, significantly more people were asleep in the lorazepam group vs. haloperidol group
  • no differences in numbers requiring more than one injection 

 

1997 Annals study:

  • 98 psychotic, agitated, and aggressive patients (73 men and 25 women)
  • IM lorazepam (2 mg), haloperidol (5 mg), or both
  • evaluated hourly after the first injection until at least 12 hours after the last.
  • Efficacy was assessed on many different assessment scales
  • tranquilization was most rapid in patients receiving the combination treatment.
  • Side effects did not differ significantly between treatment groups

 

Most common risk/benefit considerations:

Haldol (haloperidol) 

  • prolongs QT (like every other drug)
  • dystonic reactions

Ativan (lorazepam)

  • risks respiratory depression

 

BOTTOM LINE:

both Haldol (haloperidol) and Ativan (lorazepam) are decent options for agitation->sedation

both seem to work alone, work a bit better together

consider the risk benefits, but there’s a reason we’ve used these for a while.

 

References: cochrane review; article; picture

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