Haloperidol for Psychosis-Induced Aggression or Agitation (Rapid Tranquillisation)

Summary

A Cochrane review [Abstract] 1 included 41 studies with approximately 3500 patients. Few studies were undertaken in circumstances that reflect real-world practice, and most were small. Patients presented with acute exacerbation of psychotic symptoms, all were so disturbed that clinicians felt that they required rapid tranquillisation. Over 80% of patients had a diagnosis of schizophrenia. The majority of studies last 72 hours or less.

• Haloperidol vs. placebo: More people in the haloperidol group were asleep at two hours (RR 0.88, 95%CI 0.82 to 0.95; 2 RCTs, n=220) and experienced dystonia (RR 7.49, 95%CI 0.93 to 60.21; 2 RCTs, n=207).
• Haloperidol vs. aripiprazole: People in the haloperidol group required fewer injections than those in the aripiprazole group (RR 0.78, 95%CI 0.62 to 0.99; 2 RCTs, n=473). More people in the haloperidol group experienced dystonia (RR 6.63, 95%CI 1.52 to 28.86; 2 RCTs, n=477).
• Haloperidol vs. lorazepam: There were no significant differences in the number of patients asleep at one hour (RR 1.05, 95%CI 0.76 to 1.44; 1 RCT, n=60) or those requiring additional injections (RR 1.14, 95%CI 0.91 to 1.43; 1 RCT, n=66).Haloperidol's adverse effects were not offset by addition of lorazepam (e.g. dystonia: RR 8.25, 95%CI 0.46 to 147.45; 1 RCT, n=67).
• Haloperidol vs. haloperidol plus promethazine: More people in the haloperidol group were not tranquil or asleep by 20 minutes compared with those in the combination group (RR 1.60, 95%CI 1.18 to 2.16; 1 RCT, n=316). Acute dystonia was too common in the haloperidol alone group for the trial to continue beyond the interim analysis (RR 19.48, 95%CI 1.14 to 331.92; 1 RCT, n=316).