Inhaled Loxapine for Agitation in Intoxicated Patients: A Case Series

Roncero, Carlos; Ros-Cucurull, Elena; Palma-Álvarez, Raúl Felipe; Abad, Alfonso Carlos; Fadeuilhe, Christian; Casas, Miquel; Grau-López, Lara

doi:10.1097/wnf.0000000000000252

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…In a majority of studies reporting safety outcomes in patients with schizophrenia or BD, inhaled loxapine was well tolerated and did not produce excessive sedation [ 53 , 54 , 55 ]. The most commonly reported adverse effects were mild to moderate and included dysgeusia, throat soreness, and sedation [ 50 , 51 , 52 , 56 ].…”

Section: Pharmacological Managementmentioning

confidence: 99%

The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

Pompili

Ducci

Galluzzo

et al. 2021

IJERPH

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The early and correct assessment of psychomotor agitation (PMA) is essential to ensure prompt intervention by healthcare professionals to improve the patient’s condition, protect healthcare staff, and facilitate future management. Proper training for recognizing and managing agitation in all care settings is desirable to improve patient outcomes. The best approach is one that is ethical, non-invasive, and respectful of the patient’s dignity. When deemed necessary, pharmacological interventions must be administered rapidly and avoid producing an excessive state of sedation, except in cases of severe and imminent danger to the patient or others. The purpose of this brief review is to raise awareness about best practices for the management of PMA in emergency care situations and consider the role of new pharmacological interventions in patients with agitation associated with bipolar disorder or schizophrenia.

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Section: Pharmacological Managementmentioning

confidence: 99%

The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

Pompili

Ducci

Galluzzo

et al. 2021

IJERPH

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show abstract

“…Key exclusion criteria of these studies were agitation primarily because of acute alcohol or drug intoxication/withdrawal and those considered to be at serious risk for suicide. Nevertheless, real-world evidence showed that acute agitation was effectively and quickly managed by inhaled loxapine in intoxicated patients in a retrospective review of data from a case series [ 42 , 43 ].…”

Section: Clinical Efficacy Of Inhaled Loxapinementioning

confidence: 99%

Inhaled Loxapine for the Management of Acute Agitation in Bipolar Disorder and Schizophrenia: Expert Review and Commentary in an Era of Change

Pacciardi

Calcedo

Messer³

2019

Drugs R D

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Agitation is a common and costly phenomenon associated with a number of psychiatric conditions including schizophrenia and bipolar disorder. Early identification and prompt intervention to relieve the symptoms of agitation are essential to avoid symptomatic escalation and emergence of aggressive behaviour. Recent consensus guidelines emphasise the need for non-coercive management strategies to protect the therapeutic alliance between patients and their healthcare providers—an alliance that is critical for the effective management of chronic psychiatric conditions. Rapid symptom relief and de-escalation of agitation are necessary to avoid the costly and traumatic use of coercive techniques of physical restraint and seclusion, which require admission and prolonged hospitalisation. Inhaled loxapine is approved for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Clinical studies have confirmed the efficacy, rapid onset of action, and safety and tolerability of this agent in the psychiatric emergency and hospital settings. Emerging data have indicated the potential for inhaled loxapine as a self-administered agent for use in the community setting without the direct supervision of a healthcare professional. We discuss the evolving treatment paradigm and the place of inhaled medications for acutely agitated patients both within and outside the emergency and hospital setting.

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“…In approval studies, it was found superior to placebo with respect to the reduction of agitation in schizophrenia and bipolar disorder (NNT = 3, 95% CI [2; 4]) (8). Hardly any data are available on its safety in patients suffering from intoxication; in a case series with 12 patients that appeared too late to be considered for the aforementioned clinical practice guideline, the only adverse effect mentioned for this population was mild confusion (33). Loxapine is, however, still contraindicated for patients with airway diseases, because of the risk of bronchospasm.…”

Section: Loxapine Inhalationmentioning

confidence: 99%

The Use of Rapid Tranquilization in Aggressive Behavior

Hirsch¹,

Steinert²

2019

Deutsches Ärzteblatt International

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ggressive behavior can be considered pathological only when it arises in the context of disease. It is thus not necessarily an indication for medical treatment. Not only emergency medical personnel and psychiatrists, but also family physicians are often confronted with the question of how to treat aggressive behavior. In one study, psychiatric emergencies accounted for 11.8% of all emergency medical interventions outside the hospital. Psychomotor agitation made up 28% of all psychiatric emergencies, second only to alcohol intoxication (33%) (1). Psychomotor agitation in the context of mental illness and intoxication constitutes a medical emergency. Affected patients can injure themselves or others. In a retrospective survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported (2). In one hospital in the federal state of North Rhine-Westphalia, 171 of the 2210 patients admitted within a 1-year period were involved in aggressive attacks, and a total of 441 episodes of aggressive behavior were reported (3). Psychomotor agitation carries the risk of somatic complications, including electrolyte disturbances, rhabdomyolysis, and lactic acidosis (4, 5). The goal of pharmacotherapy is to calm the patient. Amnesia and deep sedation should be avoided in order not to compromise the patient's ability to participate in joint decision-making about further treatment. Deep sedation also puts patients at risk of cardiorespiratory depression, aspiration, and other complications. No data on this topic are available from Germany, but an Australian study has shown that 16 agitated patients who were pharmacologically sedated (9% of the patients so treated) sustained complications such as hypotension and hypoxemia (6). The health-related causes of aggressive behavior include nearly all kinds of mental disorders, and various somatic illnesses as well. In an emergency, the history should be rapidly obtained from someone who has observed the behavior, and an initial, orienting physical examination should be performed. Intoxications, withdrawal syndromes, a postictal state, and rapidly reversible causes such as hypoglycemia should be ruled out (7). The patient's permission for pharmacotherapy should be obtained whenever possible. In Germany, when the patient refuses treatment, the physician must determine whether coercive emergency treatment is permissible and required, as per the concept of a Summary Background: Psychomotor agitation and aggressiveness in the context of mental illness are medical emergencies. In a survey of six German psychiatric hospitals, 1.7 to 5 aggressive attacks per patient-year were reported. If talking to the patient has no calming effect, intervention with drugs is required. In this article, we review the evidence on tranquilizing drugs and discuss clinically relevant ethical and practical questions, e.g., with respect to involuntary medication. Method: This review is based on pertinent articles retrieved by a selective search in MEDLINE, supplemented by a reference sear...

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Inhaled Loxapine for Agitation in Intoxicated Patients: A Case Series

Cited by 6 publications

References 24 publications

The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

The Management of Psychomotor Agitation Associated with Schizophrenia or Bipolar Disorder: A Brief Review

Inhaled Loxapine for the Management of Acute Agitation in Bipolar Disorder and Schizophrenia: Expert Review and Commentary in an Era of Change

The Use of Rapid Tranquilization in Aggressive Behavior

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