Aripiprazole (Intramuscular) for Psychosis-Induced Aggression or Agitation (Rapid Tranquillisation)

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 707 patients. A total of 74.4% of them had a diagnosis of schizophrenia. No trials reported data for one of primary outcomes of tranquil or asleep by 30 minutes.

• Aripiprazole vs. placebo: Fewer people in the aripiprazole group needed additional injections (RR 0.69, 95% CI 0.56 to 0.85; 2 RCTs, n = 382). Clinically important improvement in agitation at two hours favoured the aripiprazole group (RR 1.50, 95% CI 1.17 to 1.92; 2 RCTs, n = 382), as did the numbers of non-responders after the first injection (RR 0.49, 95% CI 0.34 to 0.71; 1 RCT, n = 263). The trend was to more people in the aripiprazole group experiencing adverse effects (RR 1.51, 95% CI 0.93 to 2.46; 1 RCT, n = 117).
• Aripiprazole vs. haloperidol: Aripiprazole required more injections compared to haloperidol (RR 1.28, 95% CI 1.00 to 1.63; 2 RCTs, n = 477), with no significant difference in agitation (RR 0.94, 95% CI 0.80 to 1.11; 2 RCTs, n = 477), and similar non-responders after first injection (RR 1.18, 95% CI 0.78 to 1.79; 1 RCT, n = 360). Aripiprazole and haloperidol did not differ when taking into account the overall number of people that experienced at least one adverse effect (RR 0.91, 95% CI 0.61 to 1.35; 1 RCT, n = 113).
• Aripiprazole vs. olanzapine: Olanzapine was better at reducing agitation (RR 0.77, 95% CI 0.60 to 0.99; 1 RCT, n = 80) and had a more favourable effect on global state change scores (MD 0.58, 95% CI 0.01 to 1.15; 1 RCT, n = 80), both at two hours. No differences were found in terms of experiencing at least one adverse effect during the 24 hours after treatment (RR 0.75, 95% CI 0.45 to 1.24; 1 RCT, n = 80). However, participants allocated to aripiprazole experienced less somnolence (RR 0.25, 95% CI 0.08 to 0.82; 1 RCT, n = 80).