Zun LS - Researchers performed this structured evidence-based review comparing the onset of efficacy of antipsychotic treatments for acute agitation. The results of this study provided valuable information to emergency physicians on the rapid efficacy of certain newer-generation antipsychotic agents for the treatment of acutely agitated patients.

Methods

• Researchers used data from randomized controlled trials identified by a literature search of the PubMed database.

Results

• Findings from 28 blinded randomized controlled trials suggested that onset of efficacy was rapid and generally observed at the first time point after intramuscular administration of ziprasidone (15-30 min) or olanzapine (15-30 min).
• However, onset of efficacy was more frequently delayed with intramuscular haloperidol, even when combined with lorazepam (30-60 min), and intramuscular aripiprazole (45-90 min).
• Rapid onset of efficacy was also consistently observed at the first assessment time point with olanzapine (15-120 min), risperidone (30-120 min), and sublingual asenapine (15 min), when administered orally.
• For inhaled loxapine, significant effects were apparent within 10-20 min.
• With i.v. Droperidol, effects were apparent within approximately 5-10 min.
• With second-generation antipsychotic agents, onset of efficacy was typically more rapid than benzodiazepines.