Table 2. Recommended intramuscular medications for rapid tranquilization in psychomotor agitation^* .

Medication	Dosage (mg)	Initial effects	Half-life	Can repeat	Maximum dosage per 24 h (mg)	Side effects	Level of evidence	Grade of recommendation
Haloperidol	2.5-10	30 min	15-37 h	30 min	30	Seizure, EPS, somnolence, headache, dizziness.	1A	A
Haloperidol + midazolam	2.5 + 7.5-15	20 min	15 h	30 min	30 for haloperidol	Excessive sedation, EPS.	1A	A
Haloperidol + promethazine	2.5-10 + 25-50	30 min	15-37 h	30 min	30/100	Excessive sedation, EPS, seizure	1A	A
Lorazepam†	2-4	20-30 min	13-18 h	1 h	4	Respiratory difficulty, nausea, dizziness with lorazepam	1A	A
Midazolam	Up to 15	15-20 min	90-150 min	30 min	-	Over sedation, respiratory depression	1A	A
Olanzapine	2.5-10	15-45 min				Excessive sedation, EPS, orthostatic hypotension, somnolence, blood urine	1A	A
Ziprasidone	10-20	1 h	2-5 h	10 (2 h)/20 (4 h)	40	Excessive sedation, EPS	1A	A
Aripiprazole†	9.75	1-3 h	75-94 h	2 h	30	Headache, dizziness, nausea, insomnia, EPSs, tachycardia	1B	A
Droperidol	2.5-10	3-10 min	3 h	30 min	20	Abnormal QT, hypotension, dizziness, EPS	2B	B
Droperidol+ midazolam	10 + 5	15 min	2 h	30 min	20/15	Abnormal QT, oversedation, respiratory depression	2B	B
Flunitrazepam†	1-2	2 h	18-26 h	24 h	2	Respiratory arrest, oversedation, hypersalivation, drowsiness, dizziness, amnesia	2B	B
Haloperidol + lorazepam†	5 + 2	30 min	18 h	1 h	15/4	Excessive sedation, EPS	2B	B
Levomepromazine†	12.5-25	20-40 min	30 h	6 h	100	Abnormal QT, hypotension, dizziness, EPS	2C	B
Clonazepam†	1-2	0.5-1 h	20-80 h	3 h	8	Respiratory arrest, oversedation, hypersalivation, drowsiness, dizziness, amnesia	4	C

^*Only recommended formulations are included. Vital signs and electrocardiogram (ECG) monitoring are recommended for patients with high cardiac risk or unknown history.

^†Not available in Brazil.

EPS = extrapyramidal side effects.