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Rapid Tranquilisation

Summary Flowchart​

Notes​

Indication:

  • Age > 16
  • If less restrictive strategies have failed
  • If there is a imminent risk of dangerous behaviour which risks the patient or others, or if the patient is exhausted

High Risk *: frail, elderly, organic brain disease, learning disability

Lorazepam

  • 1 - 2 mg Lorazepam PO/IM (0.5 - 1 mg *)
  • Repeat at 30 minutes if required
  • Alternative: Diazepam - 5 - 10 mg (2.5 - 5 mg *)

Haloperidol

  • 5 mg PO/IM (0.5 - 2 mg *) maximum 10 mg / 24 hours
  • Contraindications: NMS, dystonia, severe EPSEs, significant cardiac disease, prolonged QTc, acute alcohol withdrawal, Parkinson's, Lewy Body Dementia; caution in epilepsy
  • Acute dystonia, oculogyric crisis, laryngospasm: 5 - 10 mg Procyclidine IM, repeat at 20 minutes if required

Olanzapine

  • 5 - 10 mg PO/IM
  • Avoid in high risk patients*, and not within 30 minutes of a benzodiazepine