title: [Rapid tranquillisation; review of the literature and recommendations].
abstract: BACKGROUND
  In The Netherlands, no guidelines exist for rapid tranquillisation in the context of acute agitation, excitement or aggression secondary to a psychiatric disorder.
  
  
  OBJECTIVE
  To generate an overview of medication regimes suitable for rapid tranquillisation.
  
  
  METHODS
  A literature search was conducted focussing on the effect of medical interventions in acute excitement, agitation or aggression. Primary outcome measurements were tranquillity, being calm, sedation, or asleep within two hours. Secondary outcome measures were frequency of re-administration and adverse side effects.
  
  
  RESULTS
  Haloperidol appears as effective as lorazepam; haloperidol in combination with lorazepam does not have added value to lorazepam or haloperidol alone. Dehydrobenzperidol, risperidone, olanzapine and aripiprazole are comparable in effectiveness to lorazepam or haloperidol. Haloperidol in combination with promethazine is associated with a more rapid onset of effect than lorazepam, haloperidol or olanzapine. Midazolam is faster than the combination of haloperidol and promethazine, but requires more frequent re-administration of medication and increases the risk for respiratory depression. The literature on quetiapine was insufficient. The level of evidence, however, is modest.
  
  
  CONCLUSIONS
  Haloperidol in combination with promethazine, and olanzapine, are effective in psychotic agitation, although haloperidol plus promethazine has a more rapid onset of effect faster; lorazepam is effective in non-psychotic agitation, aggression or excitement as well as in acute agitation of unknown origin.
authors: UMC Maastricht en afdeling IntegraleZorg, Maastricht. m.bak@maastrichtuniversity.nl
authors: M
authors: M
authors: Bak
authors: J
authors: J
authors: van Os
authors: M
authors: M
authors: Marcelis
mesh_terms: D000374:Aggression / Q000187:drug effects* / Q000523:psychology; D001569:Benzodiazepines / Q000627:therapeutic use; D016292:Procedural Sedation / Q000379:methods*; D004359:Drug Therapy, Combination; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008140:Lorazepam / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use; D000077152:Olanzapine; D017410:Practice Guidelines as Topic; D011398:Promethazine / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D011398:Promethazine; D006220:Haloperidol; D000077152:Olanzapine; D008140:Lorazepam; D008874:Midazolam