Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Sep;20(9):844-9.
doi: 10.4103/1735-1995.170598.

Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial

Mehrdad Esmailian  1 , Omid Ahmadi  1 , Mehrsa Taheri  1 , Majid Zamani  1
Affiliations

Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial

Mehrdad Esmailian et al. J Res Med Sci. 2015 Sep.

Abstract

Background: Restless and violent behaviors are common in Emergency Departments (EDs), which need therapeutic interventions in most of the times. The first-generation anti-psychotic drugs are one of the most applicable therapeutic agents in the management of such patients, but their use has some limitations. Some studies suggest midazolam as an alternative medicine. Therefore, this study was performed with the aim of comparison of the efficacy and safety of haloperidol and midazolam in the restless management of referring patients to EDs.

Materials and methods: The present double-blinded trial was done on patients needed sedation and referred to the ED of Alzahra Hospital, Isfahan, Iran, in 2014. The patients were categorized into two random groups of haloperidol (5 mg) and midazolam receivers (2.5 mg for those weighing <50 kg and 5 mg in >50 kg), as intramuscular administration. The time to achieve sedation, need for rescue dose, need to resedation within the first 60 min, and adverse effects of drugs were compared among the groups.

Results: Forty-eight patients were entered to the study. The mean age in the haloperidol and midazolam groups was 44.8 ± 4.1 years and 45.5 ± 4.7 years, respectively (P = 0.91). The mean time of sedation in the haloperidol and midazolam groups was 5.6 ± 0.3 min and 5.2 ± 0.1 min, respectively (P = 0.31). The mean time of full consciousness after sedation was 36.2 ± 4.5 min and 38.2 ± 3.4 min in the haloperidol and midazolam groups, respectively (P = 0.72). On average, time to arousal in the midazolam group was 10.33 min more than the haloperidol group, but it was not statistically significant.

Conclusion: The results of the present study show that administration of midazolam and haloperidol have similar efficacy in the treatment of restless symptoms with the same recovery time from drug effects for referring patients to the ED. In addition, none of the adverse effects were observed in this study.

Keywords: Drug effects; drug prescription; emergency treatment; haloperidol; midazolam; movement disorders.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Mean and 95% CI of time to sedation and time to arousal by groups
Figure 2
Figure 2
Mean and 95% CI for time to arousal based on grading of restless before intervention by groups
Figure 3
Figure 3
Mean and 95% CI for time to arousal based on grading of restless after intervention by groups
Figure 4
Figure 4
Mean and 95% CI for time to arousal based on changes in grading of restless after intervention by groups
Figure 5
Figure 5
Consort diagram of participant flow
See this image and copyright information in PMC

References

    1. Karceski S, Morrell M, Carpenter D. The expert consensus guideline series: Treatment of epilepsy. Epilepsy Behav. 2001;2:A1–50.
    1. TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: A randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003;327:708–13. - PMC - PubMed
    1. Zun LS. An issue of equity of care: Psychiatric patients must be treated “on par” with medical patients. Am J Psychiatry. 2014;171:716–9. - PubMed
    1. Chun TH, Katz ER, Duffy SJ, Gerson RS. Challenges of managing pediatric mental health crises in the emergency department. Child Adolesc Psychiatr Clin N Am. 2015;24:21–40. - PubMed
    1. Macht M, Mull AC, McVaney KE, Caruso EH, Johnston JB, Gaither JB, et al. Comparison of droperidol and haloperidol for use by paramedics: Assessment of safety and effectiveness. Prehosp Emerg Care. 2014;18:375–80. - PMC - PubMed