Rapid Tranquillisation Prescribing

Rapid Tranquilisation Prescribing Guidelines

Last updated on: 17/08/2018

Last updated on: 17/08/2018

Medications listed are suggested and should be tailored to each patient/clinical situation.

Consider legal status of patient.

Elderly: Avoid medication unless essential. Reduce dose of lorazepam or antipsychotics (i.e. at least by half). Avoid antipsychotic in dementia.

Oral Route - offer first

All doses are adult doses

Allow at least 45 minutes for oral medication to work

Non-psychotic context: Consider;

Lorazepam 1-2mg PO (max 4mg in 24 hours)

Psychotic/manic context or aggressive: Consider*;

Haloperidol 5mg PO (max 20mg in 24 hours) OR Risperidone 1-2mg PO (max 10mg in 24 hours)

AND

Lorazepam 1-2mg PO (max 4mg in 24 hours)

Olanzapine 10mg PO (max 20mg in 24 hours) may be an option in moderate disturbance (Avoid in dementia related disturbance)

Consider procyclidine 5mg PO/IM if dystonias/EPSE

Intramuscular Route

All doses are adult doses

Allow at least 30-45 minutes for IM medication to work (2 hours for aripiprazole), before repeating dose, and then allow a further 45 minutes for effect.

Non-psychotic context: Consider;

Lorazepam 1-2mg IM (max 4mg in 24 hours)

Psychotic/manic context or aggressive: Consider;

Haloperidol 5mg IM (max 20mg in 24 hours) (Avoid Haloperidol if dementia with Lewy Bodies/previous dystonia)

Aripriprazole 5.25-9.75mg IM (max 30mg in 24 hours, max of three injections) may be considered in moderate disturbance. It may be a useful option where there is no ECG.

Consider procyclidine 5mg PO/IM if dystonias/EPSE

Links

CWPT - Rapid Tranquillisation Policy

CWPT - Medicines Management on the internet

BNF - British National Formulary

Monitoring

Monitoring effects of RT medication: Monitor in line with the policy.

Doctor to review observation chart.

Contact:

Medicines Management Team

Tel: 024 7600000 Email: prescribing@covwarkpt.nhs.uk