Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation)

• Published in: Cochrane database of systematic reviews 2012-11, Vol.11, p.CD009377-CD009377
• Main Authors: Powney, Melanie J, Adams, Clive E, Jones, Hannah
• Format: Article
• Language: English
• Subjects: Aggression - drug effects; Aggression - psychology; Antipsychotic Agents - administration & dosage; Antipsychotic Agents - adverse effects; Aripiprazole; Clopenthixol - administration & dosage; Dystonia - chemically induced; Haloperidol - administration & dosage; Haloperidol - adverse effects; Humans; Lorazepam - administration & dosage; Piperazines - administration & dosage; Psychomotor Agitation - drug therapy; Psychotic Disorders - drug therapy; Psychotic Disorders - psychology; Quinolones - administration & dosage; Randomized Controlled Trials as Topic; Sleep; Thiazoles - administration & dosage
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD009377.pub2

Haloperidol, used alone is recommended to help calm situations of aggression with people with psychosis. This drug is widely accessible and may be the only antipsychotic medication available in areas where resources are limited. To investigate whether haloperidol alone, administered orally, intramuscularly or intravenously, is effective treatment for psychosis-induced agitation or aggression. We searched the Cochrane Schizophrenia Group Trials Register (1st June 2011). Randomised controlled  trials (RCTs) involving people exhibiting agitation or aggression (or both) thought to be due to psychosis, allocated rapid use of haloperidol alone (by any route), compared with any other treatment. Outcomes included tranquillisation or asleep by 30 minutes, repeated need for rapid tranquillisation within 24 hours, specific behaviours (threat or injury to others/self), adverse effects. We independently selected and assessed studies for methodological quality and extracted data. 'Summary of findings' tables were produced for each comparison grading the evidence and calculating, where possible and appropriate, a range of absolute effects. We included 32 studies comparing haloperidol with 18 other treatments. Few studies were undertaken in circumstances that reflect real world practice, and, with notable exceptions, most were small and carried considerable risk of bias.Compared with placebo, more people in the haloperidol group were asleep at two hours (2 RCTs, n = 220, risk ratio (RR) 0.88, 95% confidence interval (CI) 0.82 to 0.95). Dystonia was common (2 RCTs, n = 207, RR 7.49, CI 0.93 to 60.21). Compared with aripiprazole, people in the haloperidol group required fewer injections than those in the aripiprazole group (2 RCTs, n = 473, RR 0.78, CI 0.62 to 0.99). More people in the haloperidol group experienced dystonia (2 RCTs, n = 477, RR 6.63, CI 1.52 to 28.86).Despite three larger trials with ziprasidone (total n = 739), data remain patchy, largely because of poor design and reporting. Compared with zuclopenthixol acetate, more people who received haloperidol required more than three injections (1 RCT, n = 70, RR 2.54, CI 1.19 to 5.46).Three trials (n = 205) compared haloperidol with lorazepam. There were no significant differences between the groups with regard to the number of participants asleep at one hour (1 RCT, n = 60, RR 1.05, CI 0.76 to 1.44). However, by three hours, significantly more people were asleep in the lorazepam group compared with the haloperidol