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

Abstract

BackgroundWhen 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concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.AimsTo ascertain what alternatives can be recommended to replace intramuscular droperidol.MethodSelective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation.ResultsCurrent 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.ConclusionsIt is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.