Table 1.

Rapidly-acting pharmacologic options for acute agitation

Agent	Dose (mg)	Advantages	Disadvantages
Lorazepam	0.5–2.0	Reliably absorbed when injected into the muscle; short half-life; no active metabolites; can potentially treat alcohol withdrawal; relatively inexpensive	No antipsychotic effect; potential for respiratory depression; risk for behavioral disinhibition (paradoxical reaction); development of tolerance
Haloperidol	0.5–7.5	Antipsychotic effect over time; relatively inexpensive	Akathisia; dystonia; will not treat underlying alcohol withdrawal
Ziprasidone	10–20	Antipsychotic effect over time; favorable extrapyramidal symptom profile compared to first-generation antipsychotics	Explicit warning in product labeling regarding prolongation of the QTc interval; will not treat underlying alcohol withdrawal; relatively more costly but availability of generic product will impact on price
Olanzapine	10 (5 or 7.5 when clinically warranted)	Antipsychotic effect over time; favorable extrapyramidal symptom profile compared to first-generation antipsychotics	Concomitant administration of intramuscular olanzapine and parenteral benzodiazepine is not recommended due to the potential for excessive sedation and cardiorespiratory depression; weight gain over time; will not treat underlying alcohol withdrawal; relatively more costly but availability of generic product will impact on price
Aripiprazole	9.75	Antipsychotic effect over time; favorable extrapyramidal symptom profile compared to first-generation antipsychotics	No dosage adjustment of aripiprazole is required when administered concomitantly with lorazepam but the intensity of sedation was greater with the combination as compared to that observed with aripiprazole alone and the orthostatic hypotension observed was greater with the combination as compared to that observed with lorazepam alone; will not treat underlying alcohol withdrawal; relatively more costly and remains under patent exclusivity at present