Author: Don Stader, MD
- Recent study showed efficacy 5mg IM midazolam > 10mg IM olanzapine > 10mg IM haloperidol for quickly sedating an agitated patient
- If you have access, ketamine intravenous is the fastest
- Olanzapine should be used with caution in elderly patients because of its anticholinergic properties
- Ketamine can transiently worsen psychosis in some mental illness
- Haloperidol is contraindicated in patients with prolonged QT
- Olanzapine can be safely given intravenous as another option to your sedating arsenal
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Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Kirshner MA, Bies RR, Kapur S, Gharabawi G. A model of anticholinergic activity of atypical antipsychotic medications. Schizophr Res. 2006 Dec;88(1-3):63-72. Epub 2006 Aug 22. PubMed PMID: 16928430.
Mankowitz SL, Regenberg P, Kaldan J, Cole JB. Ketamine for Rapid Sedation of Agitated Patients in the Prehospital and Emergency Department Settings: A Systematic Review and Proportional Meta-Analysis. J Emerg Med. 2018 Nov;55(5):670-681. doi: 10.1016/j.jemermed.2018.07.017. Epub 2018 Sep 7. PubMed PMID: 30197153.
Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD