Comparison of Haloperidol, Promethazine, Trifluoperazine, and Chlorpromazine in Terms of Velocity and Durability of the Sedation among Acute Aggressive Patients: A Randomized Clinical Trial

Document Type : Original Article

Authors
Seyed Ghafur Mousavi 1
Shima Mirnezafat 1
Mohammad Javad Tarrahi 2
1 Department of Psychiatry, Behavioral Sciences Research Center, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Knowledge and skill about sedation of aggressive patients is necessary for each psychiatrist. The purpose of this study was comparing the velocity and durability of sedation induced by the haloperidol, trifluoperazine, promethazine, and chlorpromazine in aggressive patients. Materials and Methods: This randomized clinical trial was done on 76 aggressive patients referred to Psychiatry Emergency Service of Noor Hospital of Isfahan University of Medical Sciences that were randomly divided into four groups of haloperidol, promethazine, chlorpromazine, and trifluoperazine. Patients were evaluated at 30 min intervals for aggressive symptoms, and if they did not respond to intervention after the first 30 min or if they showed aggression again, a same dose of the injected drug was prescribed. The length of sedation time was recorded for each patient. Results: Seventy-six patients with the mean age of 31.89 ± 8.73 years were participated and 63.2% of them were male. Response to intervention after the first injection was seen in 40.8% and 59.2% needed the second injection. The mean time needed for obtaining sedation was 17.38 ± 8.23 and 19.66 ± 4.64 min after the first and second injection, respectively. The mean times of sedation induction were not significantly related to age, gender, type of substance used, type of aggression, and type of psychiatric disorder. Considering the type of drugs, there was no significant difference between velocity and durability effect of sedation after the first and second injection. Conclusion: Comparing the velocity and durability of sedative effect of the four studied drugs on acute aggressive patients, did not show any significant difference between them.

Keywords

1.
Siever LJ. Neurobiology of aggression and violence. Am J Psychiatry 2008;165:429-42.  Back to cited text no. 1
    
2.
Ahmed U, Jones H, Adams CE. Chlorpromazine for psychosis-induced aggression or agitation. Schizophr Bull 2011;37:890-1.  Back to cited text no. 2
    
3.
Berk M, Rathbone J, Mandriota-Carpenter SL. Clotiapine for acute psychotic illnesses. Cochrane Database of Systematic Reviews. 2004 (4). Mantovani C, Migon MN, Alheira FV, Del-Ben CM. Management of the violent or agitated patient. Braz J Psychiatry 2010;32 Suppl 2:S96-103.  Back to cited text no. 3
    
4.
Bellnier TJ. Continuum of care: Stabilizing the acutely agitated patient. Am J Health Syst Pharm 2002;59:S12-8.  Back to cited text no. 4
    
5.
Currier GW, Trenton A. Pharmacological treatment of psychotic agitation. CNS Drugs 2002;16:219-28.  Back to cited text no. 5
    
6.
Tardy M, Huhn M, Kissling W, Engel RR, Leucht S. Haloperidol versus low-potency first-generation antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews. 2014 (7).   Back to cited text no. 6
    
7.
Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: A meta-analysis. Lancet 2009;373:31-41.  Back to cited text no. 7
    
8.
Tardy M, Dold M, Engel RR, Leucht S. Trifluoperazine versus low-potency first-generation antipsychotic drugs for schizophrenia. Cochrane Database of Systematic Reviews. 2014 (7).  Back to cited text no. 8
    
9.
Hartung B, Sampson S, Leucht S. Perphenazine for schizophrenia. Cochrane database of systematic reviews. 2015 (3).  Back to cited text no. 9
    
10.
Huf G, Coutinho ES, Adams CE, TREC-Rio trial. TREC-rio trial: A randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]. BMC Psychiatry 2002;2:11.  Back to cited text no. 10
    
11.
Adolph O, Köster S, Georgieff M, Georgieff EM, Moulig W, Föhr KJ. Promethazine inhibits NMDA-induced currents – New pharmacological aspects of an old drug. Neuropharmacology 2012;63:280-91.  Back to cited text no. 11
    
12.
Baldaçara L, Sanches M, Cordeiro DC, Jackoswski AP. Rapid tranquilization for agitated patients in emergency psychiatric rooms: A randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus midazolam and haloperidol alone. Braz J Psychiatry 2011;33:30-9.  Back to cited text no. 12
    
13.
Vishne T, Amiaz R, Grunhaus L. Promethazine for the treatment of agitation after electroconvulsive therapy: A case series. J ECT 2005;21:118-21.  Back to cited text no. 13
    
14.
Ingram DG, Hagemann TM. Promethazine treatment of steroid-induced psychosis in a child. Ann Pharmacother 2003;37:1036-9.  Back to cited text no. 14
    
15.
Terndrup TE, Cantor RM, Madden CM. Intramuscular meperidine, promethazine, and chlorpromazine: Analysis of use and complications in 487 pediatric emergency department patients. Ann Emerg Med 1989;18:528-33.  Back to cited text no. 15
    
16.
Ahmed U, Jones H, Adams CE. Chlorpromazine for psychosis induced aggression or agitation. Cochrane database of systematic reviews. 2010 (4).  Back to cited text no. 16
    
17.
Ritter RM, Davidson DE, Robinson TA. Comparison of injectable haloperidol and chlorpromazine. Am J Psychiatry 1972;129:78-81.  Back to cited text no. 17
    
18.
Eghtesadi D, Mousavi GH, Mahaki B. Comparison between Velocity of Sedation of Acute Aggressive Patients by Haloperidol, Chlorpromazine, Trifluoperazine and Promethazine; Randomized Clinical Trial [Thesis]. Isfahan University of Medical Sciences; 2017.  Back to cited text no. 18
    
19.
National Institute for Health and Clinical Excellence. The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Settings and Emergency Departments. London: National Institute for Health and Clinical Excellence; 2005.  Back to cited text no. 19
    
20.
Marco CA, Vaughan J. Emergency management of agitation in schizophrenia. Am J Emerg Med 2005;23:767-76.  Back to cited text no. 20
    
21.
Salem H, Nagpal C, Pigott T, Teixeira AL. Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges. Curr Neuropharmacol 2017;15:789-98.  Back to cited text no. 21
    
Advanced Biomedical Research
Volume 2019, june
June 2019
Pages 1-5