Chart For Rapid Tranquillisation

MedicationTime to max plasma concentrationApprox plasma half-lifeLicensed indications as at August 2004 (see current summary of product characteristics [SPC])Notes
Haloperidol injection (SPC)15–60 min

(SPC and http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
10–36h

(SPC and http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
Schizophrenia: treatment of symptoms and prevention of relapse.
Other psychoses; especially paranoid.
Mania and hypomania.
Mental or behavioural problems, such as aggression, hyperactivity and self-mutilation in the mentally retarded and in patients with organic brain damage.
As an adjunct to short-term management of moderate to severe psychomotor agitation, excitement, violent or dangerously impulsive behaviour.
Nausea and vomiting.
Haloperidol oral solution (SPC)2–6h

http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
10–36h

http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
Schizophrenia and other psychoses.
Short-term adjunctive management of psychomotor agitation, excitement, violent or dangerously impulsive behaviour, mental or behavioural disorders, especially when associated with hyperactivity and aggression. Short-term adjunctive management of severe anxiety, restlessness and agitation in the elderly, intractable hiccup, nausea and vomiting, Gilles de la Tourette syndrome and severe tics.
Haloperidol tablets (SPC)2–6 h

(http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
1–36h

(http://www​.intox.org​/databank/documents/pharm​/haloperi/ukpid24.htm)
Schizophrenia and other psychoses.
Short-term adjunctive management of psychomotor agitation, excitement, violent or dangerously impulsive behaviour, mental or behavioural disorders, especially when associated with hyperactivity and aggression. Short-term adjunctive management of severe anxiety, restlessness and agitation in the elderly, intractable hiccup, nausea and vomiting, Gilles de la Tourette syndrome and severe tics.
Lorazepam injection (SPC)60–90 min12–16hPre-operative medication or premedication for uncomfortable or prolonged investigations.
The treatment of acute anxiety states, acute excitement or acute mania.
The control of status epilepticus.
Lorazepam tablets (SPC)2h12hShort-term treatment of moderate and severe anxiety.
Short-term treatment of anxiety in psychosomatic, organic and psychotic illness.
Short-term treatment of insomnia associated with anxiety.
Pre-medication before operative dentistry and general surgery.
Olanzapine dispersable tablets (SPC)5–8h32–50hTreatment of schizophrenia.
Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response.
Treatment of moderate to severe manic episode.
In patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder.
Not approved for the treatment of dementia-related psychosis and/or behavioural disturbances.
Olanzapine injection (SPC)15–45 min32–50hIndicated for the rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episode, when oral therapy is not appropriate. Treatment with olanzapine powder for solution for injection should be discontinued, and the use of oral olanzapine should be initiated, as soon as clinically appropriate.The manufacturer has issued a warning that use outside of the details contained within the SPC may increase the risk of fatality.
i/m olanzapine may produce a five-fold increase in plasma concentration vs. the same dose given by the oral route.
Not approved for the treatment of dementia-related psychosis and/or behavioural disturbances.
Olanzapine tablets (SPC)5–8h32–50hTreatment of schizophrenia.
Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response.
Treatment of moderate to severe manic episode.
In patients whose manic episode has responded to olanzapine treatment, olanzapine is indicated for the prevention of recurrence in patients with bipolar disorder.
Not approved for the treatment of dementia-related psychosis and/or behavioural disturbances.
Risperidone dispersable tablets (SPC)1–2h24hThe treatment of acute and chronic schizophrenic psychoses, and other psychotic conditions, in which positive or negative symptoms are prominent.
Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response.
Treatment of mania in bipolar disorder.
Not licensed for the treatment of behavioural symptoms of dementia.
Risperidone liquid (SPC)1–2h24hThe treatment of acute and chronic schizophrenic psychoses, and other psychotic conditions, in which positive or negative symptoms are prominent.
Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response.
Treatment of mania in bipolar disorder.
Not licensed for the treatment of behavioural symptoms of dementia.
Risperidone tablets (SPC)1–2h24hThe treatment of acute and chronic schizophrenic psychoses, and other psychotic conditions, in which positive or negative symptoms are prominent.
Maintaining the clinical improvement during continuation therapy in patients who have shown an initial treatment response.
Treatment of mania in bipolar disorder.
Not licensed for the treatment of behavioural symptoms of dementia.

From: 8, Recommendations and good practice points

Cover of Violence
Violence: The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments.
NICE Clinical Guidelines, No. 25.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2006, Royal College of Nursing.

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