Table 16.

Use of benzodiazepines and typical antipsychotics in agitation

Medication class	Medication	Dosing	Side effects/considerations
Atypical antipsychotics	Risperidone	PO, OTD	No IM form is available
		Starting dose 0.5-2 mg acutely	Offers calming effect with the treatment of the underlying condition
			Orthostatic hypotension with reflex tachycardia
			Increased risk of stroke in the elderly with CVD
	Olanzapine	PO, OTD, IM	Useful in patients with poor reaction to haloperidol
		Starting dose 2.5-5 mg, maximum 30 mg/24 h with doses 2-4 h apart	Calming medication with the treatment of the underlying disorder
	Aripiprazole	PO, OTD	Akathisia risk
		Starting PO dose 5-10 mg, maximum 30 mg/day (currently IM formulation only for extended-release maintenance therapy)	Less sedating than other medications
			Increased risk of stroke in the elderly
			Good choice for patients with QT interval prolongation
Combinations	Haloperidol, lorazepam, diphenhydramine, or benzatropine	5 mg IM, 2 mg IM, 50 mg IM, 1 mg IM	Most commonly used in the acute setting
			Young athletic men are at increased risk for dystonia
			Akathisia must be considered if agitation increases after administration

PO – Per os (by mouth, orally); OTD – Orally disintegrating tablet; IM – Intramuscular; CVD – Cardiovascular disorder