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