Droperidol, Ziprasidone or Ativan for Agitation Control in the ED

Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double-blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Acad Emerg Med. 2021 Apr;28(4):421-434. doi: 10.1111/acem.14124. Epub 2020 Oct 5. PMID: 32888340.

The answer is still Droperidol however given the small sample size this still needs to be interpreted with caution!

The authors do however state that this confirms “findings from a retrospective chart review of 4,947 patients at our institution sedated with droperidol that demonstrated a 17% rescue sedation rate”.(1) However, “a prospective study from Australia of 1,403 patients receiving droperidol for acute agitation found a higher rescue rate of 31%”.(2)

  1. Calver L, Page CB, Downes MA, et al. The safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the emergency department. Ann Emerg Med 2015;66:230–8.e1. 0.1016/j.annemergmed.2015.03.016
  2. Klein LR, Driver BE, Horton G, Scharber S, Martel ML, Cole JB. Rescue sedation when treating acute agitation in the emergency department with intramuscular antipsy- chotics. J Emerg Med 2019;56:484–90.

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