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Haloperidol plus promethazine for psychosis-induced aggression.
Gisele Huf1, Jacob Alexander, Michael H Allen
1Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Avenida Brigadeiro Trompowski, s/no, Ilha do Fundao, RJ Rio de Janeiro, Brazil, CEP 21949-900.
The Cochrane Database of Systematic Reviews
|July 10, 2009
Summary
Haloperidol plus promethazine effectively calms agitation and aggression in psychosis patients. While generally safe, benzodiazepines like midazolam pose risks of respiratory depression, and haloperidol alone causes adverse effects.
Area of Science:
- Psychiatry
- Pharmacology
- Emergency Medicine
Background:
- Agitation and aggression are common in emergency psychiatric services, occurring in 10% of cases.
- Effective pharmacological interventions are crucial for rapid and safe patient sedation.
Purpose of the Study:
- To evaluate the efficacy of haloperidol plus promethazine for treating agitation and aggression induced by psychosis.
Main Methods:
- Searched the Cochrane Schizophrenia Group's Register for randomized clinical trials.
- Included studies comparing haloperidol plus promethazine with midazolam, lorazepam, haloperidol alone, or olanzapine IM.
- Analyzed data using risk ratios (RR) and confidence intervals (CI), calculating NNT/H where applicable.
Main Results:
- Haloperidol plus promethazine effectively sedated patients within 30 minutes in Brazil and India.
- Compared to midazolam, it was less swift; compared to lorazepam, it was more effective.
- Intramuscular haloperidol plus promethazine showed faster tranquilization than haloperidol alone.
- Haloperidol alone led to significant adverse effects; olanzapine IM had a shorter duration of action.
Conclusions:
- Haloperidol plus promethazine demonstrates swift, safe, and clinically valuable effects for psychosis-induced agitation.
- Benzodiazepines carry risks of respiratory depression, necessitating careful monitoring.
- Haloperidol monotherapy should be avoided due to preventable adverse effects.
- Olanzapine IM is effective but requires repeat dosing more frequently than haloperidol plus promethazine.
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