nice, 2005

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/