Table 2

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/ designStudy drugs and dosing (mg/injection or dose) and adm routeCombCl ApsBenzCombCl ApsBenzDefinition of improvementTime for defined improve mentCombCl ApsBenzConclusionStudy 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/DBRLorazepam 2 mg im/ haloperidol 5 mg im/ combination of them im917174323531Need for 3 or less doses of study medication3 hours6203Combination is significantly more effectiveED/24 hours
GarzaTrevino/ 1989/randomLorazepam 4 mg im/ haloperidol 5 mg im/ combination of them im1007183242123VAS becoming ⩽20 mm60 minutesNot statedNot statedNot statedCombination is significantly more effectiveNot stated/ 210 minutes
Bieniek/1998/ DBRLorazepam 2 mg im/ haloperidol 5 mg im plus lorazepam 2 mg im10055911Decrease of 4 or more points on OAS60 minutes00Combination is significantly more effectiveED/3 hours
Barbea/1992/ DBRAlprozolam 1 mg po plus haloperidol 5 mg po/ haloperidol 5 mg po93641414BPRS psychotism subscale <12, or sedated4 hours3664Combination is significantly more effectiveED/72 hours
Dorevitch/ 1999/DBRFlunitrazepam 1 mg im/ haloperidol 5 mg im92801315Improvement of at least 50% in OAS90 minutes00No significant difference in efficacyInpatient/2 hours
Chouinard/ 1993/DBRClonazepam 1–2 mg im/ haloperidol 5–10 mg im756388Improvement of 50% on IMPS manic symptoms subscale2 hours130No significant difference in efficacy (Cl Aps faster action)Inpatient and ED/2 hours
Salzman/ 1991/DBLorazepam 2 mg im/ haloperidol 5 mg im27592622% of patients who had greater than mean improvement on OAS2 hours505Benz has a significantly superior efficacyInpatient/ 24 hours
Richards/ 1998/randomLorazepam 2–4 mg iv/droperidol 2.5–5 mg iv9260102100Sedation scale score being <430 minutes10Droperidol (Cl Aps) has a significantly superior efficacyED/1 hour
Foster/1997/ DBRLorazepam 2 mg im/po / haloperidol 5 mg im/po35362017% Improvement in BPRS according to baseline4 hours00No significant difference in efficacy (Benz po is recommended by authors)ED/4 hours
Wyant/1990/ SBRMidazolam 5 mg im/ haloperidol 10 mg im/ sodium amytal 250 mg im34*75*55Improvement indicated by CGRS on motor agit mean score, according to maximum possible improvement)2 hoursNot statedNot statedBenz more effective than Cl Aps on motor agitationInpatient/2 hours
Richards/1997 /randomLorazepam 2–4 mg iv/ droperidol 2.5–5 mg iv71557274% Improvement in sedation scale score according to baseline60 minutes10Droperidol (Cl Aps) produces more rapid and profound sedationED/60 minutes