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Conventional intramuscular sedatives versus ziprasidone for severe agitation in adolescents: case-control study.

Jangro WC, Preval H, Southard R, Klotz SG, Francis A - Child Adolesc Psychiatry Ment Health (2009)

Bottom Line: No difference was found in restraint duration (ziprasidone, N = 28, 55 +/- 5 minutes; haloperidol with lorazepam N = 24, 65 +/- 7 minutes, P = NS).Use of "rescue" medications did not differ between the two groups.No changes in blood pressure were found, but pulse decreased 8.3 +/- 2.4 for haloperidol with lorazepam and 8.9 +/- 4.24 for ziprasidone (P = NS).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychiatry & Behavioral Sciences, SUNY at Stony Brook, Stony Brook, NY 11794, USA. william.jangro@sunysb.edu

ABSTRACT

Objective: The objective of this study was to compare intramuscular (IM) ziprasidone to conventional IM medications (haloperidol combined with lorazepam) for the treatment of severe agitation in adolescents (age 12-17).

Methods: We retrospectively identified consecutive severe agitation episodes (defined as requiring physical restraint) in adolescents treated with either IM ziprasidone or conventional IM agents in a psychiatric emergency room. For ziprasidone, the dosage was 20 mg for 23 episodes and 10 mg for 5 episodes. For 24 episodes treated with combined haloperidol and lorazepam, the dosages were 4.8 +/- 0.3 SEM mg and 1.9 +/- 0.4 mg respectively. Outcomes were the duration of restraint and need for adjunctive "rescue" medications within 60 minutes. These outcomes were decided prior to reviewing any records.

Results: No difference was found in restraint duration (ziprasidone, N = 28, 55 +/- 5 minutes; haloperidol with lorazepam N = 24, 65 +/- 7 minutes, P = NS). Use of "rescue" medications did not differ between the two groups. No changes in blood pressure were found, but pulse decreased 8.3 +/- 2.4 for haloperidol with lorazepam and 8.9 +/- 4.24 for ziprasidone (P = NS). No instances of excessive sedation or extra-pyramidal symptoms were documented.

Conclusion: In this study, IM ziprasidone appeared effective, well tolerated, and similar in clinical profile to combined conventional IM medications for treating severe agitation in adolescents. Given the reportedly favorable acute side effect profile of parenteral atypical agents, they may provide an alternative to conventional antipsychotics for treating acute agitation in both adult and adolescent populations. Future randomized, controlled studies are needed.

No MeSH data available.


Related in: MedlinePlus

Blood pressure/heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS). SYS = systolic blood pressure; DIA = diastolic blood pressure; HR = heart rate; PRE = prior to treatment with IM medication; POST = after treatment with IM medication.
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Figure 3: Blood pressure/heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS). SYS = systolic blood pressure; DIA = diastolic blood pressure; HR = heart rate; PRE = prior to treatment with IM medication; POST = after treatment with IM medication.

Mentions: Ziprasidone IM was well tolerated in adolescents as shown in Figure 3. For adolescents, usable blood pressure and heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS) (figure 3). Of 28 ziprasidone cases, 4 post treatment ECGs were available and showed normal QTc (387–451 milliseconds). There were no recorded extrapyramidal reactions or administrations of anticholinergic agents.


Conventional intramuscular sedatives versus ziprasidone for severe agitation in adolescents: case-control study.

Jangro WC, Preval H, Southard R, Klotz SG, Francis A - Child Adolesc Psychiatry Ment Health (2009)

Blood pressure/heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS). SYS = systolic blood pressure; DIA = diastolic blood pressure; HR = heart rate; PRE = prior to treatment with IM medication; POST = after treatment with IM medication.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2663548&req=5

Figure 3: Blood pressure/heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS). SYS = systolic blood pressure; DIA = diastolic blood pressure; HR = heart rate; PRE = prior to treatment with IM medication; POST = after treatment with IM medication.
Mentions: Ziprasidone IM was well tolerated in adolescents as shown in Figure 3. For adolescents, usable blood pressure and heart rate data were available for 18 patients before and after ziprasidone IM and 12 for combined conventional agents. No overall pre-post changes in blood pressure were found, but pulse decreased 8.3 ± 2.4 for haloperidol combined with lorazepam and 8.9 ± 4.24 for ziprasidone (P = NS) (figure 3). Of 28 ziprasidone cases, 4 post treatment ECGs were available and showed normal QTc (387–451 milliseconds). There were no recorded extrapyramidal reactions or administrations of anticholinergic agents.

Bottom Line: No difference was found in restraint duration (ziprasidone, N = 28, 55 +/- 5 minutes; haloperidol with lorazepam N = 24, 65 +/- 7 minutes, P = NS).Use of "rescue" medications did not differ between the two groups.No changes in blood pressure were found, but pulse decreased 8.3 +/- 2.4 for haloperidol with lorazepam and 8.9 +/- 4.24 for ziprasidone (P = NS).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychiatry & Behavioral Sciences, SUNY at Stony Brook, Stony Brook, NY 11794, USA. william.jangro@sunysb.edu

ABSTRACT

Objective: The objective of this study was to compare intramuscular (IM) ziprasidone to conventional IM medications (haloperidol combined with lorazepam) for the treatment of severe agitation in adolescents (age 12-17).

Methods: We retrospectively identified consecutive severe agitation episodes (defined as requiring physical restraint) in adolescents treated with either IM ziprasidone or conventional IM agents in a psychiatric emergency room. For ziprasidone, the dosage was 20 mg for 23 episodes and 10 mg for 5 episodes. For 24 episodes treated with combined haloperidol and lorazepam, the dosages were 4.8 +/- 0.3 SEM mg and 1.9 +/- 0.4 mg respectively. Outcomes were the duration of restraint and need for adjunctive "rescue" medications within 60 minutes. These outcomes were decided prior to reviewing any records.

Results: No difference was found in restraint duration (ziprasidone, N = 28, 55 +/- 5 minutes; haloperidol with lorazepam N = 24, 65 +/- 7 minutes, P = NS). Use of "rescue" medications did not differ between the two groups. No changes in blood pressure were found, but pulse decreased 8.3 +/- 2.4 for haloperidol with lorazepam and 8.9 +/- 4.24 for ziprasidone (P = NS). No instances of excessive sedation or extra-pyramidal symptoms were documented.

Conclusion: In this study, IM ziprasidone appeared effective, well tolerated, and similar in clinical profile to combined conventional IM medications for treating severe agitation in adolescents. Given the reportedly favorable acute side effect profile of parenteral atypical agents, they may provide an alternative to conventional antipsychotics for treating acute agitation in both adult and adolescent populations. Future randomized, controlled studies are needed.

No MeSH data available.


Related in: MedlinePlus