Summary of the studies comparing benzodiazepines, classic antipsychotics, and the combination of both in the treatment of acute agitation
| Improvement rate (%) | Sample size (number included in the analysis) | Incidence of EPS side effects (%) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Source/year/ design | Study drugs and dosing (mg/injection or dose) and adm route | Comb | Cl Aps | Benz | Comb | Cl Aps | Benz | Definition of improvement | Time for defined improve ment | Comb | Cl Aps | Benz | Conclusion | Study environment and duration |
| *Numeric data are estimated from the graphic presentation. DBR, double blind randomised; SBR, single blind randomised; DB, double blind; random, randomised; ED, emergency department. Other abbreviations as in table 1. | ||||||||||||||
| Battaglia/1997/DBR | Lorazepam 2 mg im/ haloperidol 5 mg im/ combination of them im | 91 | 71 | 74 | 32 | 35 | 31 | Need for 3 or less doses of study medication | 3 hours | 6 | 20 | 3 | Combination is significantly more effective | ED/24 hours |
| GarzaTrevino/ 1989/random | Lorazepam 4 mg im/ haloperidol 5 mg im/ combination of them im | 100 | 71 | 83 | 24 | 21 | 23 | VAS becoming ⩽20 mm | 60 minutes | Not stated | Not stated | Not stated | Combination is significantly more effective | Not stated/ 210 minutes |
| Bieniek/1998/ DBR | Lorazepam 2 mg im/ haloperidol 5 mg im plus lorazepam 2 mg im | 100 | 55 | 9 | 11 | Decrease of 4 or more points on OAS | 60 minutes | 0 | 0 | Combination is significantly more effective | ED/3 hours | |||
| Barbea/1992/ DBR | Alprozolam 1 mg po plus haloperidol 5 mg po/ haloperidol 5 mg po | 93 | 64 | 14 | 14 | BPRS psychotism subscale <12, or sedated | 4 hours | 36 | 64 | Combination is significantly more effective | ED/72 hours | |||
| Dorevitch/ 1999/DBR | Flunitrazepam 1 mg im/ haloperidol 5 mg im | 92 | 80 | 13 | 15 | Improvement of at least 50% in OAS | 90 minutes | 0 | 0 | No significant difference in efficacy | Inpatient/2 hours | |||
| Chouinard/ 1993/DBR | Clonazepam 1–2 mg im/ haloperidol 5–10 mg im | 75 | 63 | 8 | 8 | Improvement of 50% on IMPS manic symptoms subscale | 2 hours | 13 | 0 | No significant difference in efficacy (Cl Aps faster action) | Inpatient and ED/2 hours | |||
| Salzman/ 1991/DB | Lorazepam 2 mg im/ haloperidol 5 mg im | 27 | 59 | 26 | 22 | % of patients who had greater than mean improvement on OAS | 2 hours | 50 | 5 | Benz has a significantly superior efficacy | Inpatient/ 24 hours | |||
| Richards/ 1998/random | Lorazepam 2–4 mg iv/droperidol 2.5–5 mg iv | 92 | 60 | 102 | 100 | Sedation scale score being <4 | 30 minutes | 1 | 0 | Droperidol (Cl Aps) has a significantly superior efficacy | ED/1 hour | |||
| Foster/1997/ DBR | Lorazepam 2 mg im/po / haloperidol 5 mg im/po | 35 | 36 | 20 | 17 | % Improvement in BPRS according to baseline | 4 hours | 0 | 0 | No significant difference in efficacy (Benz po is recommended by authors) | ED/4 hours | |||
| Wyant/1990/ SBR | Midazolam 5 mg im/ haloperidol 10 mg im/ sodium amytal 250 mg im | 34* | 75* | 5 | 5 | Improvement indicated by CGRS on motor agit mean score, according to maximum possible improvement) | 2 hours | Not stated | Not stated | Benz more effective than Cl Aps on motor agitation | Inpatient/2 hours | |||
| Richards/1997 /random | Lorazepam 2–4 mg iv/ droperidol 2.5–5 mg iv | 71 | 55 | 72 | 74 | % Improvement in sedation scale score according to baseline | 60 minutes | 1 | 0 | Droperidol (Cl Aps) produces more rapid and profound sedation | ED/60 minutes | |||