Physicians treat agitated patients daily in the emergency department (ED). In many cases, it is challenging to distinguish the cause of the agitation, and these patients require thorough workups.

A recent study compared the efficacy of four agents that can be used for undifferentiated agitation in the ED. The intramuscular medications and doses tested included haloperidol 5 mg, midazolam 5 mg, olanzapine 10 mg, haloperidol 10 mg, and ziprasidone 20 mg.
The only inclusion criterion was a patient requiring medication for acute agitation. Exclusion criteria were: age younger than 18 years, and being a prisoner or under arrest. The median age for enrolled patients was 40 years, with a range of 18-77 years.
The suspected cause of the patient's agitation was grouped as follows: alcohol intoxication, drug intoxication, psychiatric, medical, or a combination of causes. The primary outcome was the proportion of patients adequately sedated at 15 minutes.
Data revealed that midazolam 5 mg had the highest proportion of patients adequately sedated at 15 minutes compared with the other medications. Olanzapine 10 mg had a higher proportion of patients adequately sedated at the 15-minute mark than did haloperidol 5 mg, haloperidol 10 mg, and ziprasidone 20 mg. Complication rates were low overall and similar across the different medications.

What first-line medications do medical professionals use to sedate agitated patients?
- Midazolam: 29%
- Haloperidol: 45%
- Ziprasidone: 3%
- Olanzapine: 11%
- Other: 12%

See reference for more information.

Adapted from Medscape News & Perspective. Sedating agitated patients: a comparison of five regimens. Internet. Available at https://www.medscape.com/viewarticle/908100?src=WNL_infoc_200229_MSCPEDIT_droperidol&uac=6705FY&impID=2295264&faf=1 Accessed on March 4, 2020. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-tim