- |||||||||| Current Evidence-Based Review of the Evaluation and Management of Pediatric Aggression (East Ballroom (New York Hilton Midtown); In-person) - Sep 30, 2023 - Abstract #AACAP2023AACAP_1680;
The following classes of medications will be described, along with the evidence guiding their support: antihistamines (1 randomized controlled trial of PRN diphenhydramine vs placebo), benzodiazepines (no studies identified for the use of benzodiazepines for this indication), typical antipsychotics (haloperidol: randomized controlled trial and haloperidol vs lithium), atypical antipsychotics (risperidone: randomized controlled trial on an inpatient unit, 2 randomized controlled trials for the intellectually disabled patients; olanzapine: open-label, prospective study; intramuscular [IM] ziprasidone vs IM olanzapine retrospective chart review; ziprasidone vs IM haloperidol and IM lorazepam), stimulants (randomized controlled trial of methylphenidate extended-release tablets vs methylphenidate using aggression as secondary outcome measure), mood stabilizers (lithium: randomized controlled trial on inpatient unit), and antidepressants (bupropion: 4-site randomized controlled trial). The effect sizes of the medications will be discussed, along with Consensus Guidelines for this topic:
- |||||||||| olanzapine / Generic mfg.
Journal: Evaluation of intramuscular olanzapine and ziprasidone in the medically ill. (Pubmed Central) - Jan 29, 2021
Additionally, their use appeared to be well-tolerated, and no patient developed Torsades de Pointes even when combined with other agents that putatively increase QTc. Given the retrospective, single-center, nonrandomized design of this study, the safety and effectiveness of these parenteral second-generation antipsychotics in common causes of acute agitation should continue to be further evaluated.
- |||||||||| ziprasidone mesylate injection / Generic mfg.
Clinical, Journal: Ziprasidone in treating bipolar child and adolescent patients: More research is warranted. (Pubmed Central) - Apr 11, 2020
Oral ziprasidone (ziprasidone hydrochloride) has been approved by the U.S. Food and Drug Administration (FDA) in 2001 for the treatment of schizophrenia, and acute manic or mixed episodes associated with bipolar disorder (BPD) with or without psychotic features. Ziprasidone intramuscular (ziprasidone mesylate) is FDA-approved for acute agitation in patients with schizophrenia.
- |||||||||| Adasuve (staccato loxapine) / AOP Orphan Pharma, Teva, Ferrer Internacional, Galen, Medivir, olanzapine / Generic Mfg.
Clinical, Review, Journal: Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults. (Pubmed Central) - Sep 10, 2019
Additionally, the use of inhaled loxapine can be associated with dysgeusia and throat irritation. Inhaled loxapine requires some degree of patient cooperation, and therefore may not be appropriate for all agitated patients.
- |||||||||| midazolam hydrochloride / Generic mfg., haloperidol / Generic mfg.
Trial completion, Trial completion date, Trial primary completion date: MOHZA: Olanzapine, Haloperidol, Ziprasidone, Midazolam for Acute Undifferentiated Agitation (clinicaltrials.gov) - Mar 16, 2018
P=N/A, N=737, Completed,
Inhaled loxapine requires some degree of patient cooperation, and therefore may not be appropriate for all agitated patients. Recruiting --> Completed | Trial completion date: Jul 2018 --> Oct 2017 | Trial primary completion date: Jun 2018 --> Oct 2017
- |||||||||| ziprasidone mesylate injection / Generic mfg.
Enrollment change, Trial withdrawal, Trial primary completion date: Ziprasidone vs Standard Therapy for Agitated Patients in the ED (clinicaltrials.gov) - Sep 13, 2017
P4, N=0, Withdrawn,
Trial primary completion date: Sep 2017 --> Dec 2017 N=300 --> 0 | Active, not recruiting --> Withdrawn | Trial primary completion date: Jan 2010 --> Jul 2011
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