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Addiction. 2017 Jul;112(7):1262-1269. doi: 10.1111/add.13780. Epub 2017 Feb 28.

Intravenous midazolam-droperidol combination, droperidol or olanzapine monotherapy for methamphetamine-related acute agitation: subgroup analysis of a randomized controlled trial.

Author information

1
Centre for Medicine Use and Safety, Monash University, Parkville, Australia.
2
Emergency Department, Austin Health, Heidelberg, Australia.
3
Emergency Department, Royal Melbourne Hospital, Parkville, Australia.
4
Pharmacy Department, Austin Health, Heidelberg, Australia.
5
Emergency Department, St Vincent's Hospital, Fitzroy, Australia.
6
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
7
Pharmacy Department, Ballarat Health Services, Ballarat, Central, Australia.
8
St Vincent's Hospital and The University of Melbourne, Fitzroy, Australia.

Abstract

AIM:

To examine the efficacy and safety of (1) midazolam-droperidol versus droperidol and (2) midazolam-droperidol versus olanzapine for methamphetamine-related acute agitation.

DESIGN AND SETTING:

A multi-centre, randomized, double-blind, controlled, clinical trial was conducted in two Australian emergency departments, between October 2014 and September 2015.

PARTICIPANTS:

Three hundred and sixty-one patients, aged 18-65 years, requiring intravenous medication sedation for acute agitation, were enrolled into this study. We report the results of a subgroup of 92 methamphetamine-affected patients.

INTERVENTION AND COMPARATOR:

Patients were assigned randomly to receive either an intravenous bolus of midazolam 5 mg-droperidol 5 mg combined, droperidol 10 mg or olanzapine 10 mg. Two additional doses were administered, if required: midazolam 5 mg, droperidol 5 mg or olanzapine 5 mg, respectively.

MEASUREMENTS:

The primary outcome was the proportion of patients sedated adequately at 10 minutes. Odds ratios with 95% confidence intervals (ORs, 95% CI) were estimated.

FINDINGS:

The baseline characteristics of patients in the three groups were similar. At 10 minutes, significantly more patients in the midazolam-droperidol group [29 of 34 (85.3%)] were sedated adequately compared with the droperidol group [14 of 30 (46.7%), OR = 6.63, 95% CI = 2.02-21.78] or with the olanzapine group [14 of 28 (50.0%), OR 5.80, 95% CI = 1.74-19.33]. The number of patients who experienced an adverse event (AE) in the midazolam-droperidol, droperidol and olanzapine groups was seven of 34, two of 30 and six of 28, respectively. The most common AE was oxygen desaturation.

CONCLUSION:

A midazolam-droperidol combination appears to provide more rapid sedation of patients with methamphetamine-related acute agitation than droperidol or olanzapine alone.

KEYWORDS:

Droperidol; emergency care; methamphetamine; midazolam; olanzapine; psychomotor agitation; sedation

PMID:
28160494
DOI:
10.1111/add.13780
[Indexed for MEDLINE]

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