Rapid tranquillisation: time for a reappraisal of options for parenteral therapy.
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concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.


OBJECTIVE
To ascertain what alternatives can be recommended to replace intramuscular droperidol.


METHODS
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.
McAllister-Williams
R Hamish
RH
Department of Psychiatry, University of Newcastle, Newcastle upon Tyne, UK. r.h.mcallister-willaims@ncl.ac.uk
Ferrier
I Nicol
IN
D000208:Acute Disease; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001569:Benzodiazepines; D003006:Clopenthixol / Q000008:administration & dosage*; D003645:Death, Sudden / Q000209:etiology; D004329:Droperidol / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D011618:Psychotic Disorders / Q000188:drug therapy*
D014151:Anti-Anxiety Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003006:Clopenthixol; D006220:Haloperidol; D004329:Droperidol