How to sedate a patient.

Summary:

• For severely violent patients requiring immediate sedation, give a rapidly acting typical antipsychotic or benzodiazepine alone (droperidol or midazolam) or a combination of a typical antipsychotic and a benzodiazepine (eg, haloperidol and lorazepam).
• For patients with agitation from drug intoxication or withdrawal, give a benzodiazepine.
• For patients with undifferentiated agitation, we prefer benzodiazepines, but typical antipsychotics are a reasonable choice.
• For agitated patients with a known psychiatric disorder, we prefer typical antipsychotic agents, but atypical antipsychotics are a reasonable choice.

Therefore,

• Haloperidol (5mg IM) + lorazepam (2mg IM) /diazepam[Pref. IV or oral (5-10mg)/midazalam[ I.V.: Initial: 0.5-2 mg slow I.V. over at least 2 minutes; slowly titrate to effect by repeating doses every 2-3 minutes if needed; usual total dose: 2.5-5 mg; use decreased doses in elderly.]
• or olanzapine (S/L wafer)
• Consider resperidone.
  
• Haloperidol has been used effectively for many years to control violent and agitated patients [69,70]. It can be given IV, IM, or orally, although its IV use is not approved by the United States Food and Drug Administration (FDA). It is usually given in doses of 2.5 to 10 mg. The onset of action is within 30 to 60 minutes. The dose should be decreased by one half in the elderly. Some clinicians give repeat doses as frequently as every 15 to 20 minutes in patients with severe agitation until the desired level of sedation is achieved, but according to the manufacturer doses may be repeated every 30 minutes.
• Lorazepam is commonly used due to its rapidity of action, effectiveness, short half-life, and intramuscular (IM) or intravenous (IV) route of administration [58]. The usual dose is 0.5 to 2 mg IV or IM. Some experts give doses as frequently as every 10 minutes for severely agitated patients, although standard sources of drug information suggest a dosing interval of 30 minutes. The half-life of lorazepam is 10 to 20 hours.
• Olanzapine and risperidone are the preferred medications for acutely agitated geriatric patients with dementia [82]. However, deaths have been reported following such use and the US FDA has released an advisory [83,84]. In the elderly patient, the dose for these medications should be decreased.