A retrospective analysis of intramuscular haloperidol and intramuscular olanzapine in the treatment of agitation in drug- and alcohol-using patients.
OBJECTIVE
The treatment of agitation in drug- and alcohol-using emergency patients is understudied.


METHODS
We performed a retrospective chart review of 105 agitated emergency department patients who received either intramuscular (IM) haloperidol or IM olanzapine, comparing prescribing patterns, level of agitation, response to treatment and side effects in patients positive for drugs or alcohol [D/A(+)] and patients negative for drugs or alcohol [(D/A(-)].


RESULTS
The haloperidol-benzodiazepine combination was the most frequently prescribed treatment in both groups, although alcohol(+) status biased clinicians toward using haloperidol alone. Overall, D/A(+) and D/A(-) patients responded to the initial intervention at similar rates, although D/A(+) patients were rated as more agitated and had more posttreatment sedation than D/A(-) patients. In D/A(+) patients, haloperidol+benzodiazepine and IM olanzapine performed better than haloperidol alone. There were no serious adverse events with any treatment.


CONCLUSIONS
Findings support the generalization of efficacy data from more rarified agitated samples to populations with high rates of substance use and highlight the need for prospective, inclusive, randomized trials comparing the commonly used haloperidol-benzodiazepine combination with newer injectable antipsychotics.
MacDonald
Kai
K
Department of Psychiatry, University of California, San Diego, San Diego, CA 92093, USA. ksmacdonald@ucsd.edu
Wilson
Michael P
MP
Minassian
Arpi
A
Vilke
Gary M
GM
Perez
Rachel
R
Cobb
Patrice
P
Tallian
Kimberly
K
Becker
Olga
O
Feifel
David
D
D019973:Alcohol-Related Disorders / Q000150:complications*; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D006220:Haloperidol / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007273:Injections, Intramuscular; D000077152:Olanzapine; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*
D018726:Anti-Dyskinesia Agents; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D006220:Haloperidol; D000077152:Olanzapine