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Page CB, Parker LE, Rashford SJ, Kulawickrama S, Isoardi KZ, Isbister GK. Prospective study of the safety and effectiveness of droperidol in elderly patients for pre-hospital acute behavioural disturbance. Emerg Med Australas 2020; 32:731-736. [PMID: 32216048 DOI: 10.1111/1742-6723.13496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Acute behavioural disturbance in the elderly (≥65 years) is a significant issue for emergency medical services with increasing prevalence of dementia and aging populations. We investigated the pre-hospital safety and effectiveness of droperidol in the elderly with acute behavioural disturbance. METHODS This was a pre-hospital prospective observational 1-year study of elderly patients with acute behavioural disturbance. The primary outcome was proportion of adverse events (AEs) (airway intervention, oxygen saturation <90% and/or respiratory rate <12/min, systolic blood pressure <90 mmHg, sedation assessment tool score of -3 and dystonic reactions). Secondary outcomes included time to sedation, additional sedation, proportion with successful sedation. RESULTS There were 149 patients (males 78 [52%], median age 78 years; 65-101 years) presenting on 162 occasions. Dementia was the commonest cause (107/164 [65%]) of acute behavioural disturbance. There were six AEs in five patients (5/162 [3%]; 95% confidence interval 1-7). Three had hypotension, one with associated hypoxia (80%); and two had respiratory AEs (respiratory rate, 10/min [no hypoxia] and hypoxia [88%] which required oxygen). Median time to sedation was 19 min (interquartile range 12-29 min). Additional sedation was given in 2/162 patients during ambulance transfer and 16/162 within an hour of hospital arrival; 24/162 (15%) failed to sedate in the ambulance; 16 subsequently settled in ED and 8/24 received additional sedation. Of 162, 123 (76%) patients successfully sedated, without AEs or additional sedation. Of 162, 114 (70%) patients received 5 mg, 46 (29%) received two doses of 5 mg and two patients (1%) received three doses. CONCLUSIONS Droperidol appeared to be safe and effective for pre-hospital sedation of acute behavioural disturbance in elderly patients.
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Affiliation(s)
- Colin B Page
- Clinical Toxicology Research Group, The University of Newcastle, Newcastle, New South Wales, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Clincial Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | | | - Sanjeewa Kulawickrama
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Faculty of Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Katherine Z Isoardi
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Clincial Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, The University of Newcastle, Newcastle, New South Wales, Australia.,Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
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Abstract
This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures.
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Affiliation(s)
- Awais Aftab
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University, 10524 Euclid Avenue, 8th Floor, Cleveland, OH 44106, USA.
| | - Asim A Shah
- Psychiatric Residency Education, Menninger Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030, USA; Menninger Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive Suite 600, Houston, TX 77098, USA; Mood Disorder Research Program at BT, Neuropsychiatric Center, Ben Taub Hospital/HHS, Room 2.125, 1502 Taub Loop, Houston, TX 77030, USA; Community Behavioral Health Program, Psychotherapy Services, Neuropsychiatric Center, Ben Taub Hospital/HHS, Room 2.125, 1502 Taub Loop, Houston, TX 77030, USA
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Garay RP, Citrome L, Grossberg GT, Cavero I, Llorca PM. Investigational drugs for treating agitation in persons with dementia. Expert Opin Investig Drugs 2016; 25:973-83. [PMID: 27232589 DOI: 10.1080/13543784.2016.1193155] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Agitation is common and distressing in persons with dementia, but safe, effective treatments remain elusive. In this review, the authors describe investigational compounds in ongoing or recently completed clinical trials for this indication and provide an opinion on how they may meet current therapeutic needs. AREAS COVERED Phase II and phase III clinical trials for agitation in persons with dementia were searched in US and EU clinical trial registries and in the medical literature for the period January 2013-February 2016 EXPERT OPINION: The authors searches identified 24 recent clinical trials investigating new treatments for agitation in persons with dementia. Candidate drugs in phase III development included the antipsychotic brexpiprazole, the antidepressant citalopram, the novel compound AVP-786 (deuterated-dextromethorphan/quinidine combination) and the cannabinoid nabilone. Of the compounds in phase II clinical trials, ELND005 (scyllo-inositol) is intended to progress into phase III development, based on evidence from a subgroup analysis and biomarker data. After many years without an FDA/EMA (Food and Drug Administration/European Medicines Agency) approved medication to treat agitation in persons with dementia, we may see the arrival of the first approved drug in the near future.
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Affiliation(s)
- Ricardo P Garay
- a Department of Pharmacology and Therapeutics , Craven , Villemoisson-sur-Orge , France
| | - Leslie Citrome
- b Department of Psychiatry and Behavioral Sciences , New York Medical College , Valhalla , NY , USA
| | - George T Grossberg
- c Department of Psychiatry , St Louis University School of Medicine , St Louis , MO , USA
| | - Icilio Cavero
- d Department of Safety Pharmacology , Craven , Villemoisson-sur-Orge , France
| | - Pierre-Michel Llorca
- e Centre Médico-Psychologique B, CHU, Clermont-Ferrand, EA U7280 , Université d'Auvergne , Clermont-Ferrand , France
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