Lorazepam haloperidol

Verapamil Versus Other Psychotropics. Garza-Trevino et al. (258) conducted a 4-week, randomized, double-blind study comparing verapamil with lithium for acute mania and found no clinical or statistically significant differences between the two treatments. These results are difficult to interpret, however, because data about the amount and timing of rescue medication (i.e., haloperidol, lorazepam) were not presented. Further, more patients on verapamil required these agents. 

Simultaneous alprazolam, clonazepam, diazepam, flunitrazepam, haloperidol, lorazepam, maprotiline, nitrazepeun, triazolam... 

Simultaneous amitriptyline, clomipramine, desipramine, doxepin, fluoxetine, imipramine, maprotiline, metoclopramide, norfluoxetine, nortriptyline Noninterfering carbamazepine, chlordiazepoxide, clobazam, diazepam, flurazepam, flus-pirilene, haloperidol, lorazepam, nitrazepam, nordiazepam, oxazepam, perazine, pimozide, spiroperidol, trifluperidol Interfering fluvoxamine... 

Simultaneous alprazolam, amitriptyline, amoxapine, chlordiazepoxide, chlorimipramine, clonazepam, demoxepam, diazepam, doxepin, halazepam, haloperidol, lorazepam, mapro-tiline, norfluoxetine, nortriptyline, oxazepeun, temazepam, trazodone, trimipramine... 

There is, however, a unique risk in the bipolar form that antidepressant treatment may trigger a switch into mania. This may occur either as the natural outcome of recovery from depression or as a pharmacological effect of the drug. Particular antidepressants (the selective serotonin reuptake inhibitors) seem less liable to induce the switch into mania than other antidepressants or electroconvulsive therapy. Treatment for mania consists initially of antipsychotic medication, for instance the widely used haloperidol, often combined with other less specific sedative medication such as the benzodiazepines (lorazepam intramuscularly or diazepam orally). The manic state will usually begin to subside within hours and this improvement develops further over the next 2 weeks. If the patient remains disturbed with manic symptoms, additional treatment with a mood stabilizer may help. 

Cocaine or stimulant intoxication may require administration of a small dose of a short-acting benzodiazepine (e.g., lorazepam 1 to 2 mg) for agitation or severe anxiety. Antipsychotics (e.g., haloperidol 2 to 5 mg) should be used only if psychosis is present. If hyperthermia is present, initiate cooling measures. 

Cocaine and other CNS stimulants Monitor cardiac function Lorazepam 2-4 mg IM every 30 minutes to 6 hours as needed for agitation Haloperidol 2-5 mg (or other antipsychotic agent) every 30 minutes to 6 hours as needed for psychotic behavior B2 B3... 

Hallucinogens, mari- Reassurance "talk-down Lorazepam and/or haloperidol B3... 

Phencyclidine Minimize sensory input Lorazepam and/or haloperidol as above B3... 

Agitation (acute, severe) Lorazepam Ziprasidone Risperidone Trazodone Olanzapine Quetiapine Haloperidol... 

Brief Severe Agitation. Acute management of severe agitation with physical aggression requires more definitive treatment. The first choice is haloperidol given in low doses (0.25-1 mg) as needed. Lorazepam can also be helpful if used briefly. Risperidone, olanzapine, quetiapine, or trazodone can also be used but are not available in injectable forms. 

FIGURE 50.3 Childhood aggression or agitation pharmacological approach. DPH, diphenhydramine CLON, clonidine LZP, lorazepam CLZ, clonazepam HAL, haloperidol DRO, droperidol. 

Intravenous administration of low-dose, high-potency agents is also an option in certain clinical situations. For example, i.v. haloperidol, alone or in combination with i.v. lorazepam, has been safe and effective in managing delirium in critically ill, medical patients ( 152, 153). At times, effective doses of haloperidol may be as low as 0.5 to 1 mg when given by this route. Alternatively, droperidol may offer some advantages over haloperidol, including overall efficacy, safety, and rapidity of onset (.154). 

An open, comparative study of 14 acutely psychotic patients treated with lorazepam alone n = 8, mean dose, 20.9 mg/day) or lorazepam plus haloperidol (mean dose, 15 mg/day mean dose, 5.2 mg/day, respectively) demonstrated a significant decrease in psychotic symptoms over 48 hours (118). Although the improvement in both groups was equal, the doses of haloperidol were low, and there was no comparative placebo group. 

Lorazepam (2 mg i.m.) was found to be equivalent to haloperidol (5 mg i.m.) either alone or when added to ongoing antipsychotic treatment, and significantly reduced the likelihood of akathisia and dystonia (167). In the treatment of acute mania, lorazepam has also been reported useful as an adjunct to lithium, as well as antipsychotics (157, 163, 165, 168, 169). 

Lennox RH, Newhouse PA, Creelman WL, et al. Adjunctive treatment of manic agitation with lorazepam versus haloperidol a double-blind study. J Clin Psychiatry 1992 52 47-52. 

Saizman C, Solomon D, Miyawaki E, et al. Parenteral lorazepam versus parenteral haloperidol forthe control of psychotic disruptive behavior. J Clin Psychiatry 1991 52 177-180. 

Guz L, Moraea R, Sartoretto JN. The therapeutic effects of lorazepam in psychotic patients treated with haloperidol a double-blind study. Curr TherRes 1972 14 767-774. 

Lorazepam. Lenox et al. (118) found lorazepam and haloperidol comparable in efficacy when used as adjuncts to lithium in a double-blind study of 20 acutely manic patients. Interestingly, another report comparing lorazepam with clonazepam found a better outcome with lorazepam, using mean doses of 12 to 13 mg (119). 

Breitbart W, Marotta R, Platt MM, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996 153 231-237. 

A 14-year-old African-American girl with acute lymphocytic leukemia was treated with dexamethasone 24 mg/day for 25 days. Four days after starting to taper the dose she had a psychotic reaction with visual hallucinations, disorientation, agitation, and attempts to leave the floor. Her mother refused treatment with haloperidol. Steroids were withdrawn and lorazepam was given as needed. Nine days later the symptoms had not improved. She was given risperidone 1 mg/day within 3 days the psychotic reaction began to improve and by 3 weeks the symptoms had completely resolved. 

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