(b) rapid control of agitation and aggression

Intramuscular route
First choice:
lorazepam
ormidazolam
Second choice:
lorazepam
ormidazolam
+/-haloperidol
Third choice:
haloperidol
+/-promethazine
Formulations/Dose
  • haloperidol injection 5mg/mL: by intramuscular injection, 5mg repeated after 2 hours if necessary; max. daily parenteral dose 10mg.
  • lorazepam injection 4mg/mL: by intramuscular injection, 2mg repeated after one hour if necessary; max. daily parenteral dose 4mg.
  • midazolam injection 1mg/mL: by intramuscular injection, 5mg repeated after one hour if necessary; maximum dose 10mg daily.
  • promethazine injection 25mg/mL: by intramuscular injection.  To be given as per protocol.  Maximum 50mg IM daily.
Prescribing Notes
  • Rapid tranquilisation is an urgent situation and intramuscular medication is necessary when the oral route is not possible or appropriate.
  • A benzodiazepine is always recommended as first line treatment.
  • Olanzapine 10mg IM is an alternative for patients who have known acute dystonic sensitivity to haloperidol.  Refer to SPC for guidance on administration and contra-indications.