Lookup NU author(s): Professor Hamish McAllister-Williams,
Professor Nicol Ferrier
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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concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.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.
Author(s): Ferrier IN; McAllister-Williams RH
Publication type: Review
Publication status: Published
Journal: British Journal of Psychiatry
ISSN (print): 0007-1250
ISSN (electronic): 1472-1465