Despite minimal information on their comparative safety and efficacy, antipsychotic and sedative combos were widely utilized in the emergency department to manage agitation. For a study, researchers sought to assess the effectiveness and safety of haloperidol, lorazepam, and diphenhydramine (B52) vs. haloperidol and lorazepam (52) in the treatment of acute agitation.

Adult patients 18 years of age who received either B52 or 52 at a Banner Health institution between August 2017 and September 2020 were included in this multicenter, retrospective cohort trial. Patients were excluded if they had a pre-existing mobility issue or were on alcohol withdrawal. The primary goal was to administer further agitation medication(s) within 2 hours following B52 or 52. The incidence of extrapyramidal symptoms, length of stay, and additional safety precautions were secondary outcomes.

There was no difference in the frequency with which additional agitation medication(s) were administered (B52: n=28 [14%] vs. 52: n = 40 [20%]; P=0.11). Patients given 52 were more likely to require antimuscarinic medicine within two days (15 vs. 6 patients, P=0.04). None of the patients who took antimuscarinic medication exhibited extrapyramidal symptoms. When compared to the B52 group, the 52 groups had a shorter length of stay (13.8 vs. 17 h; P=0.03), a lower incidence of hypotension (7 vs. 32 patients; P=0.001), oxygen desaturation (0 vs. 6 patients; P=0.01), and fewer physical restrictions (53 vs. 86 patients; P=0.001). Both the B52 and 52 combinations required repeat agitation medication occasionally; however, the B52 combination resulted in higher oxygen desaturation, hypotension, utilization of physical restraints, and a longer stay.