Table 2.

Parenteral and inhaled pharmacological treatments for psychomotor agitation.

Class	Drug	Mode of Admin	Dose Range (mg)	Adverse Effects	Contraindications	Treatment Associations and Recommendations
FGA	Haloperidol	IM	5–30	NMS Extrapyramidal side effects Torsade de pointes QT prolongation	Severe cardiovascular disorders History of seizures EEG abnormalities Dementia-related psychosis Parkinson’s disease Haloperidol hypersensitivity	Lorazepam, promethazine, or diphenhydramine (low risk of NMS) FGAs should only be administered during pregnancy if the benefit clearly outweighs the potential risk to the fetus Use with caution in patients < 17 years of age.
		IV	5–20	Falls Torsade de pointes Cardiac arrest Sudden death
	Chlorpromazine	IM	50–150	Hypotension Falls Pain at the site of injection NMS Extrapyramidal side effects Alpha-adrenergic effects	History of seizures Dementia-related Psychosis
		IV	25–50	Prolonged unconsciousness Sudden death (for high doses)
	Loxapine	Inhalation	9.1–18.2	Extrapyramidal side effects	Asthma Chronic obstructive pulmonary disease	Evidence of use in minors unavailable
	Zuclopenthixol Acetate	IM	50–150	Fatal cardiac events Sudden death	Patients requiring immediate effect onset (delayed onset of about 8 h) Children and adolescents
	Promazine	IM	50–300	Hypotension Somnolence Dizziness Paralytic ileus Ketoacidosis NMS	Coma Bone marrow depression Pheochromocytoma Central nervous system depression Promazine hypersensitivity	In children ≥ 12 years and adolescents, dosage should not exceed 0.25–0.50 mg/kg
SGA	Aripiprazole	IM	10–30	Low risk of extrapyramidal effects Cardiovascular effects	Cardiovascular disorders	Lorazepam The safety and efficacy of aripiprazole injection have not been established in subjects ≤ 17 years
	Ziprasidone	IM	10–40	DRESS	Cardiovascular disorders	The safety and efficacy of ziprasidone injection have not been established in subjects ≤ 17 years
	Olanzapine	IM	10–20	Hypotension Bradycardia Cardiorespiratory depression	Substance or alcohol abuse Contraindicated in association with benzodiazepines	Administration with BDZ. isn’t recommended due to safety considerations. The safety and efficacy of olanzapine injection have not been established in subjects ≤ 17 years
BZD	Lorazepam	IM IV	2–8	Respiratory depression Ataxia Excessive sedation Memory impairment Paradoxical disinhibition	Intra-arterial administration Use in neonates or infants Acute narrow-angle glaucoma Severe respiratory insufficiency Alcohol dependence and abuse Sleep apnea	Oral risperidone Use lower dosages in children and adolescents Drug of choice for psychomotor agitation in epilepsy
	Diazepam	IV	10–40	Respiratory depression Ataxia Excessive sedation Memory impairment Paradoxical disinhibition	Intra-arterial administration Use in neonates or infants Acute narrow-angle glaucoma Severe respiratory insufficiency Alcohol dependence and abuse Sleep apnea	Use lower dosages in children and adolescents Useful for psychomotor agitation in epilepsy
Others (when antipsychotics or BDZs are contraindicated)	Sodium valproate	IV	400–1200	Increased liver enzymes Hepatotoxicity Excessive sedation Ataxia	Intra-arterial administration Use in neonates or infants Hepatic disorders Porphyria Coagulopathies Pregnancy and breastfeeding Mitochondrial disorders such as Alpers-Huttenlocher syndrome	IV sodium valproate doesn’t have direct psychiatric indications in the product label Useful for psychomotor agitation in epilepsy

Italicized drugs or modes of administration are not recommended. BZD, benzodiazepine; DRESS, drug reaction with eosinophilia and systemic symptoms; EEG, electroencephalogram; FGA, first-generation antipsychotic; IM, intramuscular; IV, intravenous; NMS, neuroleptic malignant syndrome; SGA, second-generation antipsychotic.