Rapid tranquillisation in a psychiatric emergency hospital in Lebanon: TREC-Lebanon – a pragmatic randomised controlled trial of intramuscular haloperidol and promethazine v. intramuscular haloperidol, promethazine and chlorpromazine

Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies in...

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Veröffentlicht in:Psychological medicine 2022-10, Vol.52 (13), p.2751-2759
Hauptverfasser: Dib, Joseph E., Yaacoub, Hiba Edward, Ikdais, Werner Henry, Atallah, Elie, Merheb, Tony Jean, Ajaltouni, Jean, Akkari, Myriam, Mourad, Marc, Nasr, Maria Elias, Hachem, Dory, Kazour, Francois, Tahan, Fouad, Haddad, Georges, Azar, Jocelyn, Zoghbi, Marouan, Haddad, Chadia, Hallit, Souheil, Adams, Clive E.
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container_end_page 2759
container_issue 13
container_start_page 2751
container_title Psychological medicine
container_volume 52
creator Dib, Joseph E.
Yaacoub, Hiba Edward
Ikdais, Werner Henry
Atallah, Elie
Merheb, Tony Jean
Ajaltouni, Jean
Akkari, Myriam
Mourad, Marc
Nasr, Maria Elias
Hachem, Dory
Kazour, Francois
Tahan, Fouad
Haddad, Georges
Azar, Jocelyn
Zoghbi, Marouan
Haddad, Chadia
Hallit, Souheil
Adams, Clive E.
description Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists. A pragmatic randomised open trial (September 2018-July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg. Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47-1.50]. Neither intervention consistently impacted the outcome of 'calm', or 'asleep' and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.
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Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists. A pragmatic randomised open trial (September 2018-July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg. Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47-1.50]. 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subjects Aggressive behavior
Aggressiveness
Antipsychotic Agents - therapeutic use
Chlorpromazine
Chlorpromazine - therapeutic use
Clinical trials
Consent
Drug dosages
Haloperidol
Haloperidol - adverse effects
Hospitals, Psychiatric
Humans
Intervention
Lebanon
Mental disorders
Original Article
Patient safety
Patients
Promethazine
Promethazine - therapeutic use
Psychomotor Agitation
Recurrence
Risk factors
Sedation
Side effects
Uncertainty
title Rapid tranquillisation in a psychiatric emergency hospital in Lebanon: TREC-Lebanon – a pragmatic randomised controlled trial of intramuscular haloperidol and promethazine v. intramuscular haloperidol, promethazine and chlorpromazine
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