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Use of Antipsychotics and/or Benzodiazepines as Rapid Tranquilization in In-Patients of Mental Facilities and Emergency Departments: A Review of the Clinical Effectiveness and Guidelines

Last updated: October 29, 2015
Project Number: RC0718-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. ​What is the clinical effectiveness and safety of using intra-muscular antipsychotics and/or intra-muscular benzodiazepines as rapid tranquilization for in-patients in mental facilities or emergency departments?
  2. What are the evidence-based guidelines for using intra-muscular antipsychotics and/or intra-muscular benzodiazepines as rapid tranquilization for in-patients in mental facilities or emergency departments?

Key Message

Evidence from three RCTs and four SRs provides inconsistent evidence regarding the comparative efficacy and safety of antipsychotics and benzodiazepines, with some studies suggesting they are similar, while others favouring one treatment over another. One notable exception, however, is that there appears to be relatively consistent evidence that intramuscular haloperidol is less effective and more harmful than other therapies. One guideline suggests using IM lorazepam or a combination of IM haloperidol and promethazine as rapid tranquilization for adults in in-patient psychiatric or emergency department settings, and IM lorazepam for children and young people.