title: First-generation Antipsychotics Are Often Prescribed in the Emergency Department but Are Often Not Administered with Adjunctive Medications.
abstract: BACKGROUND
  Although first-generation antipsychotics (FGAs) have long been used in the emergency department (ED) to treat acute agitation, little is known about how these medications are used in modern clinical practice. In particular, little work has been published about whether ED clinicians administer FGAs with adjunctive medications in accordance with expert guidelines or the prescribing practices of FGAs over time.
  
  
  OBJECTIVE
  1) To provide a comparison of the frequency with which FGAs are administered with adjunctive benzodiazepines or anticholinergic medications. 2) To analyze the prescribing trends for FGAs over time, particularly in the years after the U.S. Food and Drug Administration (FDA) black-box warning for droperidol.
  
  
  METHODS
  This is a structured review of a retrospective cohort of patients receiving haloperidol or droperidol in two EDs over a 7-year period.
  
  
  RESULTS
  Haloperidol or droperidol was administered on 2833 patient visits during the study period, with haloperidol being administered most often. Adjunctive medications are administered less than half of the time. The use of droperidol has remained relatively static, whereas the use of haloperidol has increased.
  
  
  CONCLUSIONS
  First-generation antipsychotics are still widely utilized in the ED. When administered, these medications are used with adjunctive medications that may decrease side effects less than half of the time. Droperidol use has remained unchanged in the years after the FDA black-box warning, whereas use of haloperidol has continued to rise.
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Campillo
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California; Department of Emergency Medicine, University of California San Diego, San Diego, California.
authors.forename: Edward
authors.initials: E
authors.lastname: Castillo
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California; Department of Emergency Medicine, University of California San Diego, San Diego, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California.
authors.forename: Austin
authors.initials: A
authors.lastname: Hopper
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ryan
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, San Diego, California; Department of Emergency Medicine, University of California San Diego, San Diego, California.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D004329:Droperidol / Q000008:administration & dosage*; D004636:Emergency Service, Hospital; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents; D006220:Haloperidol; D004329:Droperidol
keywords: droperidol; emergency department; first-generation antipsychotics; haloperidol