Promethazine for the Treatment of Agitation After Electroconvulsive Therapy

Abstract

In this small case series, we found that promethazine can be used to prevent post-ECT agitation. Further double-blind controlled studies are needed to better evaluate the usefulness and appropriateness of promethazine in the prevention of pre-ECT fears and post-ECT agitation.

Premedication with dexmedetomidine and midazolam attenuates agitation after electroconvulsive therapy

“…Droperidol, propofol, promethazine, and midazolam have been studied for severe post-ECT agitation. The results suggest that these drugs can be used to prevent post-ECT agitation [12,15,19]. It is important to emphasize that even promethazine is a highly effective treatment for post-ECT agitation.…”

“…It is important to emphasize that even promethazine is a highly effective treatment for post-ECT agitation. However, it is a dopamine blocker, and thus can cause extrapyramidal effects and neuroleptic malignant syndrome [15].…”

“…The agitation was evaluated using an emergence agitation (behavior score) score (1 = sleeping, 2 = awake and calm, 3 = irritable and crying, 4 = inconsolable crying, 5 = severe restlessness and disorientation purposelessly wanting to get out of the bed, wanting to stand on the bed, shouting, crying, or mumbling loudly) [15]. Patients' satisfaction was assessed using a satisfaction scale, in which 1 represents pleased and calm, 2 represents the patient is without any complaint and satisfaction is not bad, 3 represents the patient has some complaints and has middling quality of satisfaction, and 4 represents complaints that the treatment is unpleasant, and he/she does not want to undergo the same technique any more.…”

Uncommon but serious complications associated with electroconvulsive therapy: Recognition and management for the clinician

“…Propofol in boluses of 0.1 to 2.0 mg/kg initially after seizure, followed by an infusion if needed (25-150 μg/kg per minute) has been shown to be an effective intervention when other pharmacologic therapies have been unsuccessful in managing this clinical problem [3•]. An oral alternative to these intravenous medications, promethazine, 25 to 50 mg given orally 2 hours before each ECT session, also has been proposed for prophylaxis of PIA [8].…”

“…Episodes of PIA occur on a spectrum of severity and range from mild and self-limiting to very severe. Very severe episodes require emergent interventions to control the acute situation along with subsequent prophylactic measures at future sessions so as to avoid premature ECT discontinuation [7,8].…”