is used for the management of acute agitated functional psychosis or extreme agitation induced by stimulants or hallucinogenic drugs, especially when drug-induced agitation has not responded to a benzodiazepine.
has a more rapid onset and greater efficacy for agitation and is also useful for drug- or toxin-induced nausea and vomiting, but its role in routine therapy is uncertain because of reports of deaths and a “black box” warning about QT prolongation (see Item IV.D below). Therefore, other antiemetic drugs (eg, metoclopramide [See Metoclopramide] and ondansetron [See Ondansetron]) should be considered as first-line drugs to control persistent nausea and vomiting.
Olanzapine and ziprasidone
by the IM route are approved for the management of acute agitation associated with schizophrenia, in addition to bipolar mania for olanzapine. Both have been used for the management of acute undifferentiated agitation of either psychiatric or organic (eg, drug-induced) origin. Their role in therapy remains to be determined, and superiority over haloperidol is not established. Ziprasidone may have a more delayed onset. Their use in elderly, hemodynamically unstable, or diabetic patients may be disadvantageous.
Note: Benzodiazepines are the usual first-line therapy for stimulant (eg, cocaine or amphetamine) intoxications and alcohol withdrawal syndromes.
may be preferred for anticholinergic-induced agitated delirium.