Table 2.
Safety procedures (required or suggested) to reduce the risk of severe adverse effects during IM treatment of agitation.
| Im drug | Main risks | Reference | Compulsory safety procedure | Useful safety procedures |
|---|---|---|---|---|
| Haloperidol | Torsade de pointe | Meyer-Massetti et al. (2010) | Pre-treatment ECG required | Post-treatment ECG |
| Tisdale et al. (2001) | No antipsychotic combination | Electrolyte balance assessment | ||
| Hassaballa and Balk (2003) Hassaballa and Balk (2003) Jackson et al. (1997) | No familiar, preceding or ongoing cardiovascular disorder No concomitant drug affecting QTc | Tox-screen Neurological assessment | ||
| No concomitant General Medical Condition affecting QTc | ||||
| Chlorpromazine | Severe hypotension | Ahmed et al. (2010) | Pressure monitoring | Test dose before full dose |
| Muench and Hamer (2010) | Pre-treatment ECG useful | |||
| Electrolyte balance assessment | ||||
| Lorazepam | Respiratory depression (lower) | Gillies et al. (2005) Riker and Fraser (2009) | No drugs or GMC affecting respiratory function | Blood test Check for acidosis / anion gap |
| Propylene glycol toxicity | Cawley (2001) | Flumazenil available | Check for alcohol intoxication | |
| Wilson et al. (2000) | ||||
| Zar et al. (2007) | ||||
| Arcangeli et al. (2005) | ||||
| Diazepam | Respiratory depression Propylene glycol toxicity | Denaut et al. (1974/1975) Boomsma et al. (2006) Arcangeli et al. (2005) | No drugs or General Medical Condition affecting respiratory function | Blood test useful Check for acidosis / anion gap Check for alcohol intoxication |
| Brice et al. (2003) | Flumazenil available | |||
| Peppers (1996) | ||||
| Zar et al. (2007) | ||||
| Midazolam | Respiratory depression (high) | Nordt and Clark (1997) Boomsma et al. (2006) Huf et al. (2005) | No drugs or general medical condition affecting respiratory function | Informed consent (off label) Blood test useful Check for alcohol intoxication |
| Spain et al. (2008) | Flumazenil available | |||
| Olanzapine | Cardiorespiratory depression in combination with BDZs | Wilson et al. (2012a) Wilson et al. (2012b) |
Avoid BDZs combination | None |
| Ziprasidone | QTc prolongation (controversial) | None | None | Pre-treatment ECG |
| Aripiprazole | None | None | None | None |