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Evidence-Based Review Of Pharmacotherapy For Acute Agitation. Part 2: Safety
1Chair, Department of Emergency Medicine, Chicago Medical School, Chicago, Illinois and Attending, Department of Emergency Medicine, Mount Sinai Hospital, Chicago, Illinois.
The Journal of Emergency Medicine
|February 14, 2018
Summary
Newer antipsychotics offer improved safety for acute agitation compared to older drugs. Newer agents reduce risks of extrapyramidal symptoms (EPS) and over-sedation, but QT prolongation remains a concern with some.
Area of Science:
- Emergency Medicine
- Pharmacology
- Psychiatry
Background:
- Acute agitation management in emergency departments often relies on rapid-acting antipsychotics.
- Limited comparative studies exist on the safety of these agents in acute settings.
Purpose of the Study:
- To compare the safety profiles of various antipsychotic medications used for acute agitation.
- To provide evidence-based guidance on the risks associated with these drugs.
Main Methods:
- A structured evidence-based review of randomized controlled trials (RCTs).
- Literature search conducted on the PubMed database.
- Analysis of data from 34 blinded RCTs.
Main Results:
- Common adverse effects included headache, dizziness, insomnia, and somnolence for second-generation antipsychotics and haloperidol.
- Differences observed in extrapyramidal symptoms (EPS), sedation levels, and acute QTc prolongation.
- Newer agents showed improved safety regarding EPS and over-sedation compared to haloperidol and benzodiazepines.
Conclusions:
- Certain newer-generation antipsychotics demonstrate enhanced safety for treating acute agitation.
- Risk of QT interval prolongation and torsade de pointes should be considered with haloperidol and some second-generation antipsychotics.
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