Agitation Management Guidelines

Primary Recommendations

The National Institute for Health and Care Excellence (NICE) recommends benzodiazepines as first-line therapy for anxiety or agitation in patients able to swallow, specifically lorazepam 0.5-1 mg orally four times daily as needed, with reduced doses of 0.25-0.5 mg for elderly or debilitated patients 1, 2
For delirium-related agitation, haloperidol 0.5-1 mg orally at night and every 2 hours when required is the guideline-recommended approach, with dose increases in 0.5-1 mg increments as needed, according to the NICE guidelines 1, 2
The American College of Physicians and other guideline societies recommend addressing reversible causes first before initiating any pharmacological treatment, including exploring patient concerns, ensuring effective communication and orientation, treating hypoxia, urinary retention, or constipation 1, 2

Promethazine carries significant risks, including adverse effects such as hypotension, respiratory depression, neuroleptic malignant syndrome, and extrapyramidal effects ranging from restlessness to oculogyric crises, as reported in the medical literature 4