Oral solution effective alternative to injections
Many physicians rely on intramuscular (IM) injections of antipsychotic drugs to treat patients who need emergency room care for psychotic agitation. However, an oral solution form of risperidone is as effective and may be a more acceptable alternative to injections for both caregivers and patients, says a study presented at the annual meeting of the American Psychiatric Association held recently in Chicago.
The study found that oral solution risperidone works as quickly and effectively as IM injection of haloperidol. Both medications were administered in combination with the anti-anxiety drug lorazepam.
"When there are two drugs that are equally efficacious, a physician’s next consideration when selecting an antipsychotic drug in emergency situations should be patient choice and compliance," says Glenn Currier, MD, lead investigator and assistant professor of the departments of psychiatry and emergency medicine at the University of Rochester (NY). "When patients experiencing psychotic agitation end up in the emergency room, they often are confused, scared, and paranoid. Injections are painful and can be perceived as hostile and coercive. This can be a significant barrier to the physician’s ability to deliver good care and to the patient’s ability to accept it," he says.
By contrast, he notes, an oral solution is more easily administered in emergency situations than pills or injections and is noninvasive. In addition, patients can continue on the same medication when they leave the hospital, which encourages long-term compliance. Further, injections expose staff members at hospitals and other facilities to an increased risk of needlesticks and a resulting exposure to diseases such as AIDS and hepatitis, especially when staff are interacting with agitated, sometimes violent patients, he adds.
Researchers studied 60 psychotic, agitated patients treated in the emergency room of a large, urban medical center. Patients were designated to receive either risperidone oral solution (2 mg) in combination with oral lorazepam (2 mg) or IM haloperidol (5 mg) with IM lorazepam (2 mg).
Researchers assessed the degree of agitation experienced by the patients — and the improvement demonstrated following treatment — using the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression (CGI) scale. The agitation scores for patients in both groups were comparable at baseline and declined significantly in both groups at both 30 and 60 minutes following administration of medication.
Other findings include:
• PANSS scores dropped sharply in both groups from the 20 to 25 "extreme" range to the seven to 12 range within the first 30 minutes.
• PANSS scores in both groups dropped to the two to five range at 60 minutes.
• CGI ratings were evaluated at 15, 30, 60, and 120 minutes. On average, CGI scores for all patients approached two, near the "very much improved" end of the scale, following medication.
• No adverse side effects were reported in the risperidone group, but one patient required IM haloperidol to manage continued agitation.
• One patient in the IM haloperidol group experienced acute dystonia.
Risperidone is manufactured under the brand name Risperdal by Janssen Pharmaceutica, a Belgian company with U.S. headquarters in Titusville, NJ. For details, click on the product information section of www.us.janssen.com.
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