Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department study

Battaglia, John; Moss, Sue; Rush, A. John; Kang, Jasbir; Mendoza, Ricardo; Leedom, Liane J.; Dubin, William R.; McGlynn, Charles; Goodman, Lowell I.

doi:10.1016/s0735-6757(97)90119-4

Cited by 312 publications

(198 citation statements)

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“…On the other hand, the fragility of the elderly patient, combined with the greater likelihood of their comorbidity and comedication, requires a cautious approach to dosing, so as to limit drug exposure and minimize risk. The minimum effective dose is best, particularly in view of evidence that higher loading doses do not necessarily bring about greater efficacy (Battaglia et al 1997). In the present study, the dosing scheme was designed to minimize patients' drug exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, little information is available on the immediate timecourse of other treatments for agitation. One study (Battaglia et al 1997) comparing IM injection of either lorazepam or haloperidol showed the two had approximately equal timecourses in controlling agitation, but combined administration of the two was more effective than either monotherapy by the 1-h timepoint. However, this difference disappeared by the 2-h timepoint.…”

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confidence: 99%

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Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

Meehan

Wang

David

et al. 2002

Neuropsychopharmacology

171

135

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This double-blind study investigated the efficacy and safety of rapid-acting intramuscular olanzapine in treating agitation associated with Alzheimer's disease and/or vascular dementia. At 2 h, olanzapine (5.0 mg, 2.5 mg) and lorazepam (1.0 mg) showed significant improvement over placebo on the PANSS Excited Component (PANSS-EC) and Agitation-Calmness Evaluation Scale (ACES),It has been estimated that 5% of people older than 65, and up to 20% of those aged 80 and older, are affected by dementia (Gurland and Cross 1982;Small and Jarvik 1982). Of these, nearly half exhibit behavioral disturbances, such as agitation, wandering, and violent outbursts (Kunik et al. 1994). Agitation has been defined as "inappropriate verbal, vocal, or motor activity not explainable by apparent needs or confusion" (CohenMansfield 1986), and includes both physically and verbally aggressive behaviors such as hitting, biting, and From the Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana (KMM, HW, SRD, JRN, BJ, CMB, PDF, AB), Institute of Psychiatry, Medical University of South Carolina, Charleston, South Carolina (JEM), and Senior Choice Unit, Presbyterian Hospital, Oklahoma City, Oklahoma (LMB).Address correspondence to: Dr. Alan Breier, Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, Tel.: (317) Fax: (317) 433-5101. Received February 12, 2001; revised May 23, 2001; accepted September 7, 2001.Online publication: 9/13/01 at www.acnp.org/citations/Npp 091301174.N EUROPSYCHOPHARMACOLOGY 2002 -VOL . 26 , NO . 4 Rapidly Acting IM Olanzapine in Dementia 495 screaming, and nonaggressive behaviors such as pacing, wandering, and continual requests for attention. In nursing home patients with dementia, the prevalence of these disturbances may be as high as 75% (Deutsch and Rovner 1991). Severe symptoms of agitation may require rapid treatment in the form of parenteral medication when a very rapid onset is required or when patients refuse or cannot take oral agents. In some instances, the use of medication is less desirable than alternative methods such as behavioral intervention. However, occasions arise where a pharmacological intervention is unavoidable and in the best interests of the patient. Lorazepam is commonly used for treatment of acute agitation, and the benzodiazepines are currently among the few agents available in a parenteral formulation for treatment of agitation. Use of orally administered atypical antipsychotics such as olanzapine and risperidone has met with some success in treating behavioral disturbances in patients with dementia (Clark et al. 2001;De Deyn et al. 1999;Katz et al. 1999;Street et al. 2000). A parenteral formulation of a second-generation antipsychotic might offer some advantage over their corresponding oral formulations due to faster onset of effect and utility where the patient cannot, or will not, accept oral treatment (Bianchetti et al. 1980;Schaffer et al. 1982). Rapid tranquilization with parenteral...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of Rapidly Acting Intramuscular Olanzapine, Lorazepam, and Placebo A Double-blind, Randomized Study in Acutely Agitated Patients with Dementia

Meehan

Wang

David

et al. 2002

Neuropsychopharmacology

171

135

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“…Un estudio encontró utilidad para el midazolam intramuscular en el control de pacientes psicóticos agitados 44 . En 1997, Battaglia y colaboradores 47 , en un estudio prospectivo, distribuido aleatoriamente, doble ciego y multicéntrico, estudiaron 98 psicóticos agitados divididos para recibir lorazepam (2 mg intramuscular), haloperidol (5 mg intramuscular) o ambos; los pacientes en cada grupo recibieron 1-6 dosis durante 12 horas. Aunque al final de las 12 horas no hubo diferencia significativa entre los 3 grupos, durante las primeras 3 horas el grupo de lorazepam más haloperidol tuvo una mejoría significativamente mayor, al utilizar la Agitated Behavior Scale (ABS) y la Brief Psychiatric Rating Scale modificada (MBPRS).…”

Section: El Rol De Las Benzodiazepinasunclassified

Neuroleptización rápida: una revisión

Stucchi-Portocarrero¹

2013

Rev Neuropsiquiatr

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“…18 Haloperidol and lorazepam in combination are more effective and rapid than haloperidol alone, but there is no direct comparison with droperidol. 19 Other atypical antipsychotic medications, although unavailable parenterally at this time, in-cluding clozapine, risperidone, olanzapine, quetiapine, and sertindole, have all been shown to lengthen the QT interval. [20][21][22] Benzodiazepines have been used for the agitated delirium associated with amphetamine toxicity, clearly one of the most highrisk cardiovascular scenarios, but were found less effective than droperidol, and required more repeat dosing in one center.…”

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confidence: 96%