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NICE, 2005. Psychiatric in-patients setting Onderscheid tussen Psychotic and non-psychotic context Non-psychotic: Lorazepam Psychotic: Lorazepam en Haloperidol. PIn need of “rapid tranquillisation” IHaloperidol CAny other medication OTranquil or a sleep after 20 min.. - PowerPoint PPT Presentation
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NICE, 2005
• Psychiatric in-patients setting• Onderscheid tussen Psychotic and
non-psychotic context• Non-psychotic: Lorazepam • Psychotic: Lorazepam en Haloperidol
P In need of “rapid tranquillisation”
I Haloperidol
C Any other medication
OTranquil or a sleep after 20 min.
NNT Risk of outcome in haloperidol plus promethazine
Risk of outcome other
Haloperidol versus Haloperidol plus promethazine
6 0,72 0,55
Haloperidol plus promethazine versus lorazepam
9 0,91 0,87
Haloperidol plus promethazine versus olanzapine
30 0.89 0,78
Haloperidol versus Haloperidol plus promethazine (2007)
• Haloperidol alone: 29% 5 mg, 71% 10 mg• Haloperidol plus promethazine 50%
5 mg en 50% 10 mg• Haloperidol alone 7% acute side
effects.
Haloperidol and promethazine versus lorazepam (2004)
• Lorazepam 4 mg. i.m.• Haloperidol 10 mg with 96% 50 mg
promethazine and 4% 25 mg promethazine• No dystonia, one patient with
lorazepam respiratory difficulty
Haloperidol plus promethazine versus olanzapine (2007)
• 148 of 150: 10 mg haloperidol and 50 mg promethazine, 2: 5 mg haloperidol and 25 mg promethazine• 148: 10 mg olanzapine, 2: 5mg• More additional drugs over 4 hours
with olanzapine
Conclusions
• Haloperidol plus promethazine is far better and safer than haloperidol alone• It has a faster onset compared to
lorazepam• Needs fewer medical interventions
within four hours than olanzapine
Limitations
• Open evaluation of treatment after blind allocation• Evaluation by different raters• Done in India (2) and Brasil (1)
SEH NICE 2005
• Lorazepam als nog geen diagnose en onzekerheid over medische voorgeschiedenis• Als eerder antipsychotica gebruikt:
haloperidol met lorazepam
Links
EBM calculator:http://www.ebem.org/nntcalculator.htmlLiteratuur beoordelingsformulierenhttp://www.cbo.nl/thema/Richtlijnen/EBRO-handleiding/G-Literatuurbeoordelings-formulieren/