Date | Source | Guideline | Drugs recommended | Route of admin | Comments | |
2004 | USA | American Psychiatric Association (APA) | Dissolvable olanzapine/risperidone OR Concentrate formulation of risperidone/haloperidol | PO | Droperidol: in selected clinical situations of extreme emergency or in highly agitated patients. | |
Haloperidol/ziprasidone/ olanzapine +/− lorazepam | IM | |||||
2005 | Canada | Canadian Psychiatric Association (CPA) | Dissolvable SGAs | PO | Zuclopenthixol acetate: recommended to avoid repeated injections, except in drug naïve patients. | |
Haloperidol 5 mg + lorazepam 2 mg OR olanzapine (2.5 - 10 mg) | IM | |||||
2005 | USA | Expert Consensus Guidelines (ECG) | Personality disorder/ Intoxication/ No data | Benzodiazepines | PO | Medication and patient characteristics govern the choice of psychotropic used |
Schizophrenia/ Mania | Olanzapine/risperidone +/−BNZ/ haloperidol + BNZ/valproex + antipsychotic | PO | ||||
Ziprasidone/quetiapine | PO | |||||
Olanzapine/ziprasidone +/− BNZ/haloperidol + BNZ | IM | |||||
2005 | UK | National Institute for Clinical Excellence Guidelines (NICE) | Haloperidol/lorazepam/ olanzapine/risperidone | PO | Olanzapine/risperidone: avoid in dementia. IV benzodiazepine/haloperidol: exceptional cases Oral or IM lorazepam alone: non-psychotic behavioural disturbance IM (haloperiodol + promethazine) /IM midazolam: very exceptional cases. Zuclopenthixol acetate: recommended in few, other than drug naïve patients. Chlorpromazine: not recommended at all. | |
Haloperidol + lorazepam OR Olanzapine | IM | |||||
2003 | USA | Patient Outcomes Research Team (PORT) | Antipsychotic + benzodiazepine | Not specified | No details explained. | |
2004 | Australia & New Zealand | Royal Australian & New Zealand College of Psychiatrists (RANZP) | Lorazepam (1 - 2 mg)/diazepam (5 - 10 mg) | PO | Typical antipsychotics: recommended as a last resort owing to risk of EPS. Haloperidol: least effective strategy. Alternative options: chlorpromazine (50 - 100 mg PO)/clonazepam (0.5 - 2 mg IM)/olanzapine(IM). Droperidol (IM): in nonresponsive cases. Zuclopenthixol acetate: recommended to avoid frequent injections even in drug naïve patients. IV midazolam may be used for rapid onset of action. | |
Olanzapine wafers (5 - 10 mg)/ quetiapine (50 - 100 mg) | PO | |||||
Midazolam 5 mg | IM | |||||
2003 | USA | Texas Implementation of Medication Algorithms (TIMA) | Benzodiazepine/FGA | PO/IM | Benzodiazepines (lorazepam 1 - 8 mg/day, clonazepam 0.5 - 2 mg/day) & FGAs: preferred over SGAs irrespective of route. SGAs seem less effective for agitation/ excitement of an acute exacerbation. | |
Risperidone solution | PO | |||||
Olanzapine/ziprasidone | IM |