Haloperidol for sedation of disruptive emergency patients

Clinton, Joseph E.; Sterner, Steven; Stelmachers, Zigfrid; Ruiz, Ernest

doi:10.1016/s0196-0644(87)80179-8

Cited by 94 publications

(31 citation statements)

References 9 publications

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“…Although the D2 receptor, and in particular, the dopamine system, is not the only neurotransmitter implicated in psychosis, interruption of dopamine transmission nonetheless relieves psychotic symptoms in agitated patients (8)(9)(10)(11). Given this, FGAs such as haloperidol and droperidol have a long tradition of use in the ED, and may be safer than some second-generation antipsychotics in alcoholpositive patients (12)(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications

Campillo¹,

Castillo

Vilke

et al. 2015

The Journal of Emergency Medicine

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, Abstract-Background: Although first-generation antipsychotics (FGAs) have long been used in the emergency department (ED) to treat acute agitation, little is known about how these medications are used in modern clinical practice. In particular, little work has been published about whether ED clinicians administer FGAs with adjunctive medications in accordance with expert guidelines or the prescribing practices of FGAs over time. Objectives: 1) To provide a comparison of the frequency with which FGAs are administered with adjunctive benzodiazepines or anticholinergic medications. 2) To analyze the prescribing trends for FGAs over time, particularly in the years after the U.S. Food and Drug Administration (FDA) black-box warning for droperidol. Methods: This is a structured review of a retrospective cohort of patients receiving haloperidol or droperidol in two EDs over a 7-year period. Results: Haloperidol or droperidol was administered on 2833 patient visits during the study period, with haloperidol being administered most often. Adjunctive medications are administered less than half of the time. The use of droperidol has remained relatively static, whereas the use of haloperidol has increased. Conclusions: First-generation antipsychotics are still widely utilized in the ED. When administered, these medications are used with adjunctive medications that may decrease side effects less than half of the time. Droperidol use has remained unchanged in the years after the FDA black-box warning, whereas use of haloperidol has continued to rise. Ó 2015 Elsevier Inc.

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Section: Introductionmentioning

confidence: 99%

First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications

Campillo¹,

Castillo

Vilke

et al. 2015

The Journal of Emergency Medicine

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“…Discute-se ainda se este grupo de drogas tem realmente uma ação analgésica (receptores opióides?) ou se o alívio do sintoma doloroso se deve ao poder sedativo destes fármacos 24,25 . Dentre os antagonistas dopaminérgicos, utilizados em nosso meio, a clorpromazina tem-se mostrado eficaz, em diferentes regimes terapêuticos, no tratamento da crise de enxaqueca, na emergência.…”

Section: Discussionunclassified

“…Conseqüentemente, temos menor grau de sedação, e pouca ou nenhuma hipotensão postural 26 . Possui também efeitos (antagonismo) em receptores dopaminérgicos (DRD2) e serotoninérgicos 20,25,26 .…”

Section: Discussionunclassified

Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares

Monzillo¹,

Nemoto²,

Costa³

et al. 2004

Arq. Neuro-Psiquiatr.

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RESUMO -O objetivo principal deste estudo foi avaliar a resposta clínica em duas horas de dois medicamentos intravenosos (dexametasona e haloperidol) no tratamento da crise de enxaqueca refratária na emergência da Santa Casa de São Paulo. Foi também observada a presença de efeitos colaterais de ambas medicações.Avaliamos 29 pacientes, diagnosticados como portadores de enxaqueca (com e sem aura), segundo os critérios da International Headache Society.Todos referiam escore 10 de dor (escala analógica), antes do tratamento com um ou outro medicamento.Todos pacientes haviam recebido previamente dipirona (1g) intravenosa e aguardado 60 minutos, sem qualquer resposta clínica. O grupo 1 (14 pacientes) recebeu haloperidol 5 mg e o grupo 2 (15 pacientes) recebeu dexametasona 4 mg, ambas diluídas em 10 ml de água destilada.A avaliação de melhora clínica foi realizada a intervalos regulares (30, 60,90 e 120 minutos). Ambas as drogas mostraram-se igualmente eficazes no alívio da dor, após 2 horas. Entretanto o grupo 1 obteve alívio superior a 50% nos escores de dor já a partir de 30 minutos da infusão. Após 90 minutos, 100% dos pacientes estavam sem dor. Reações adversas foram observadas somente no grupo 1, não sendo importantes. PALAVRAS-CHAVE: enxaqueca, haloperidol, dexametasona, tratamento da crise, efeitos colaterais. Acute treatment of migraine in emergency room: open comparative study between dexametasone and haloperidol. Preliminary resultsABSTRACT -We studied the efficacy of dexametasone (4 mg) and haloperidol (5 mg) in the treatment of migraine in the emergency room.Twenty nine patients who had diagnosis of migraine according to the International Headache Society criteria and were evaluated for a painful episode at the emergency room of Santa Casa of São Paulo were included. All the patients scored their pain in 10 when evaluated, even after the use of intravenous analgesia (dipyrone). Fourteen patients were treated with haloperidol and the remaining 15 received dexametasone. The patients were asked about pain intensity at 30, 60, 90 and 120 minutes after the use of either the drugs. Both drugs were equally efficient in pain relief after two hours. Patients who were treated with haloperidol showed an important improvement (more than 50% of improve in the analogic pain scale) in the first 30 minutes.The dexametasone treated patients only reached this grade of analgesia after 120 minutes. Although we studied a small serie of patients, our data suggest that both drugs are efficient in the treatment of a refractory migraine attack. Haloperidol seemed to work quickly in pain relief. No important side effects were observed in neither groups.KEY WORDS: migraine, haloperidol, dexametasone, emergency room, side effects.A dor de cabeça é uma das queixas mais freqüentes na prática médica do "dia-a-dia" e constitui importante problema de saúde pública. Estima-se que 90% da população pode referir algum tipo de cefaléia em alguma época da vida. Uma parcela considerável irá necessitar de atendimento num serviço de emergência em ...

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“…HAL (with concurrent administration of benztropine 1-2 mg) clearly evident clinical improvement occurred within 5-15 min, with no medical or extrapyramidal side effects reported. Clinton et al (1987) in another open study report on the use of HAL with 136 patients in a general emergency department setting where the drug was administered to control behaviour, non-pharmacological methods having failed to deal completely with disruptive and dangerous behaviour. A variety of diagnoses were present and in all cases the patients' behaviour was preventing delivery of health care.…”

Section: Haloperidol (Hal)mentioning

confidence: 99%

Pharmacological management of aggression and violence

Humble¹,

Berk²

2003

Human Psychopharmacology

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The pharmacological management of violence and aggression is a common and substantial clinical dilemma in the emergency psychiatric situation. A literature search was conducted through PubMed and using the Cochrane Library. This was followed by a manual search of selected literature. Randomised controlled trials were sought that specifically addressed the acute situation, rather than the ongoing management of chronic conditions. There was a paucity of well-controlled data and insufficient evidence to support the use of many agents in emergency situations. Many studies had considerable limitations making comparison difficult. Efficacy data for a range of treatment options exists, including the use of classical and atypical anti-psychotic agents, benzodiazepines and combination therapies. Clinical risk, tolerability and environmental factors need to form part of a careful and considered judgement in the choice of treatment. Safety, tolerability and the potential for a positive experience are major considerations, thus paving the way for long term compliance.

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Haloperidol for sedation of disruptive emergency patients

Cited by 94 publications

References 9 publications

First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications

First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications

Tratamento agudo da crise de enxaqueca refratária na emergência: estudo comparativo entre dexametasona e haloperidol. Resultados preliminares

Pharmacological management of aggression and violence

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