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Rapid tranquillisation: time for a reappraisal of options for parenteral therapy

Lookup NU author(s): Professor Hamish McAllister-WilliamsORCiD, Emeritus Professor Nicol Ferrier

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Abstract

Background When parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn. Aims To ascertain what alternatives can be recommended to replace intramuscular droperidol. Method Selective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation. Results Current guidelines recommend haloperidol as an alternative to droperidol. There is evidence of cardiotoxicity with haloperidol and it has a propensity to cause extrapyramidal side effects that may exacerbate disturbed behaviour and reduce longer-term compliance. The rapid-acting intramuscular formulations of atypical antipsychotic agents show promise. Conclusions It is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.

Publication metadata

Author(s): Ferrier IN; McAllister-Williams RH

Publication type: Review

Publication status: Published

Journal: British Journal of Psychiatry

Year: 2002

Volume: 180

Issue: 6

Pages: 485-489

ISSN (print): 0007-1250

ISSN (electronic): 1472-1465

URL: http://dx.doi.org/10.1192/bjp.180.6.485

DOI: 10.1192/bjp.180.6.485

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