[Haloperidol plus promethazine for agitated patients--a systematic review]

Area of Science:

• Psychopharmacology
• Emergency Medicine
• Clinical Psychiatry

Background:

• Rapid and safe tranquillisation is crucial in managing acute agitation in patients with psychosis.
• The combination of haloperidol plus promethazine is frequently employed in clinical settings, particularly in Brazil, for this purpose.

Purpose of the Study:

• To conduct a systematic review evaluating the efficacy and safety of the haloperidol plus promethazine combination for rapid tranquillisation in aggressive patients with psychosis.
• To compare the effectiveness of haloperidol plus promethazine against other sedative agents like midazolam, lorazepam, haloperidol alone, and olanzapine.

Main Methods:

• Systematic review of randomised clinical trials.
• Searched the Cochrane Schizophrenia Group's Register for relevant studies.
• Included trials involving aggressive patients with psychosis treated with haloperidol plus promethazine; data extraction and quality assessment were performed.

Main Results:

• Four high-quality studies were identified.
• Haloperidol plus promethazine was effective in over two-thirds of patients within 30 minutes in Brazil.
• Compared to lorazepam in India, the combination was more effective; midazolam was faster acting. Olanzapine showed similar rapid effects but less enduring efficacy. Haloperidol alone was associated with serious adverse effects.

Conclusions:

• All evaluated treatments demonstrated effectiveness in rapid tranquillisation.
• The haloperidol plus promethazine combination presents clear advantages for managing aggressive patients with psychosis.
• Evidence supports the utility of haloperidol plus promethazine for rapid and effective sedation in psychiatric emergencies.