Antipsychotic Drugs or Benzodiazepines for Rapid Tranquilization in Mental Health Facilities or Emergency Department Settings

Key Message

• Evidence from 5 systematic reviews, 3 randomized controlled trials, and 4 observational studies provide inconsistent evidence regarding the comparative efficacy and safety of antipsychotic drugs and benzodiazepines for adults with acute aggression or agitation requiring rapid tranquilization in emergency department or mental health inpatient settings.
• Overall, the evidence came from low- to moderate-quality studies. Some studies suggested different antipsychotic drugs and benzodiazepines, alone or in combination, have similar efficacy, whereas others favoured one treatment over another.
• No studies differentiated between adults aged 18 to 64 years and those older than 65 years. Most studies included mixed ages or excluded patients older than 75 years.
• No studies differentiated between aggression or agitation associated with psychiatric illness and other etiologies such as alcohol intoxication.
• One guideline suggests initial treatment with intramuscular lorazepam, promethazine, or 1 of aripiprazole, droperidol, or olanzapine. If the desired outcome is not achieved with monotherapy, the guideline recommends an intramuscular combination of either promethazine plus haloperidol or lorazepam plus haloperidol.