Two-drug combo relieves agitation first time

Published on November 8, 2012 at 9:15 AM · No Comments

By Sarah Guy, medwireNews Reporter

The majority of advanced cancer patients who experience agitation achieve control after the first dose of an antipsychotic-antiseizure combination is administered, show study results.

Furthermore, the haloperidol plus midazolam protocol did not induce any significant complications despite being administered multiple times in some cases, note the researchers in the American Journal of Hospice and Palliative Care.

"The results are encouraging as most patients were controlled with the first dose, which means they were controlled in 30 minutes or less," writes the team.

"Agitation is a distressful and sometimes dangerous experience for all those involved, including the agitated patient. Therefore, agitation should be controlled as quickly as possible, but safely," explain Ferraz Gonçalves and co-investigators from the Portuguese Institute of Oncology, Porto.

Their findings emerge from data for 509 advanced cancer patients who were admitted to their institution between June 2007 and January 2010, of whom 27 were sedated intermittently a total of 86 times because of agitation.

Each of these sedations followed the study protocol, where urinary retention and uncontrolled pain were first ruled out, then haloperidol administered in a maximum of three doses, plus hourly midazolam if the agitation remained uncontrolled.

The researchers defined agitation as behavior including disruptive vocalizations such as calling out or screaming, as well as aggressiveness, wandering, or making other noises.

Patients were sedated a median of twice, with a range of one to 12 times, and had a median 15 minutes between the beginning of the sedation to the control of the agitation, report Gonçalves and colleagues.

For 83% of patients, only one sedation dose was needed, with 14% of patients requiring two doses to regain control of agitation, 2% requiring three doses, and just one patient needing four doses.

"What should be stressed is the quick effect of the combination of haloperidol and midazolam, without significant unwanted effects," say the study authors, who note that the patient who received the protocol 12 times did so without complications.

Indeed, this patient and others with a relatively high number of episodes of agitation were calm most of the time, remark Gonçalves et al, who recommend that "it is preferable to maintain the sedation intermittently allowing the patient to interact with others."

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