Management of Acute Aggression and Agitation in General Patients

See notes on use of risperidone & olanzapine in patients with dementia & history of, or risk factors for, cerebrovascular disease.

Always use non-drug approaches. Try talking to the patient. Use a calm and reassuring approach. Identify any treatable cause of agitation (hypoxia, shock, brain injury, hypoglycaemia, chest infection, UTI, pain, constipation, alcohol withdrawal). For the management of alcohol withdrawal, see previous section.

Patient group

1st line

2nd line

Notes

Adults

Haloperidol
1.5-5mg po TDS
3mg IM every 4-8 hours according to response
Lorazepam
1-2mg PO or 1mg IM if sedation required

Chlorpromazine
50-100mg BD po

Lorazepam
As previous

If EPSEs:
Procyclidine 5mg TDS prn.

Haloperidol is not sedating

Contact Medicines Info.
Ext 3331 for further information

Elderly

For agitation without hallucinations:
Clomethiazole
192mg TDS po
(or 250mg/5mls syrup TDS)
Lorazepam
1-3mg po/IM

For agitation with hallucinations:
Haloperidol
0.5-2mg BD
po or 1mg IM

Trazodone
50-150mg nocte (if agitation is a problem at night)
Promazine
25-50mg qds

Clomethiazole
is preferred to lorazepam for signs of agitation as it has no hangover effect.
Patients should be referred to an Old Age Psychiatrist for further advice when necessary.

Contact Medicines Information, ext 3331 for further information

Patient group	1st line	2nd line	Notes
Adults	Haloperidol 1.5-5mg po TDS 3mg IM every 4-8 hours according to response Lorazepam 1-2mg PO or 1mg IM if sedation required	Chlorpromazine 50-100mg BD po Lorazepam As previous	If EPSEs: Procyclidine 5mg TDS prn. Haloperidol is not sedating Contact Medicines Info. Ext 3331 for further information
Elderly	For agitation without hallucinations: Clomethiazole 192mg TDS po (or 250mg/5mls syrup TDS) Lorazepam 1-3mg po/IM For agitation with hallucinations: Haloperidol 0.5-2mg BD po or 1mg IM	Trazodone 50-150mg nocte (if agitation is a problem at night) Promazine 25-50mg qds	Clomethiazole is preferred to lorazepam for signs of agitation as it has no hangover effect. Patients should be referred to an Old Age Psychiatrist for further advice when necessary.
Contact Medicines Information, ext 3331 for further information