Rapid tranquillisation: time for a reappraisal of options for parenteral therapy

Abstract

Background: When parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.

Aims: To ascertain what alternatives can be recommended to replace intramuscular droperidol.

Method: Selective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation.

Results: Current guidelines recommend haloperidol as an alternative to droperidol. There is evidence of cardiotoxicity with haloperidol and it has a propensity to cause extrapyramidal side-effects that may exacerbate disturbed behaviour and reduce longer-term compliance. The rapid-acting intramuscular formulations of atypical antipsychotic agents show promise.

Conclusions: It is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.