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    Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study

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    Author
    Jeffers, Trevor
    Darling, Brenna
    Edwards, Christopher
    Vadiei, Nina
    Affiliation
    Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy
    Department of Emergency Medicine, University of Arizona College of Medicine
    Department of Psychiatry, University of Arizona College of Medicine
    Issue Date
    2022-03
    Keywords
    52
    agitation
    antipsychotic
    B52
    benzodiazepine
    efficacy
    emergency department
    extrapyramidal symptoms
    pharmacotherapy
    safety
    
    Metadata
    Show full item record
    Publisher
    Elsevier BV
    Citation
    Jeffers, T., Darling, B., Edwards, C., & Vadiei, N. (2022). Efficacy of Combination Haloperidol, Lorazepam, and Diphenhydramine vs. Combination Haloperidol and Lorazepam in the Treatment of Acute Agitation: A Multicenter Retrospective Cohort Study. Journal of Emergency Medicine.
    Journal
    Journal of Emergency Medicine
    Rights
    © 2022 Published by Elsevier Inc.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Background: Antipsychotic and sedative combinations are commonly used for treating agitation in the emergency department despite limited evidence regarding their comparative safety and efficacy. Objectives: To compare the efficacy and safety of combination haloperidol, lorazepam, and diphenhydramine (B52) to combination haloperidol and lorazepam (52) in treating acute agitation. Methods: This multicenter, retrospective cohort study included adult patients ≥ 18 years of age who received either B52 or 52 at a Banner Health facility between August 2017 and September 2020. Patients were excluded if they had a pre-existing movement disorder or were withdrawing from alcohol. The primary outcome was administration of additional agitation medication(s) within 2 h of B52 or 52. Secondary outcomes included incidence of extrapyramidal symptoms, length of stay, and additional safety measures. Results: There was no difference in administration frequency of additional agitation medication(s) (B52: n = 28 [14%] vs. 52: n = 40 [20%]; p = 0.11). Patients who received 52 were more likely to require an antimuscarinic medication within 2 days (15 vs. 6 patients, p = 0.04). Of the patients who received an antimuscarinic medication, none had documented extrapyramidal symptoms. The 52 group had shorter length of stay (13.8 vs. 17 h; p = 0.03), lower incidence of hypotension (7 vs. 32 patients; p < 0.001), and oxygen desaturation (0 vs. 6 patients; p = 0.01), and fewer physical restraints (53 vs. 86 patients; p = 0.001) compared with the B52 group. Conclusions: Both the B52 and 52 combinations infrequently required repeat agitation medication; however, the B52 combination resulted in more oxygen desaturation, hypotension, physical restraint use, and longer length of stay.
    Note
    12 month embargo; available online: 12 March 2022
    ISSN
    0736-4679
    DOI
    10.1016/j.jemermed.2022.01.009
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jemermed.2022.01.009
    Scopus Count
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    UA Faculty Publications

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