Inhaled Loxapine Effective as Anti-Agitation Agent in Emergency Settings

doctor and nurse pulling stretcher
Inhaled loxapine may be an effective, non-invasive alternative to the intramuscular sedatives typically used to treat agitation in the emergency department.

The following article is part of conference coverage from the 2019 American Psychiatric Association Annual Meeting (APA 2019) in San Francisco, CA. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry. Check back for the latest news from APA 2019.

SAN FRANCISCO — In an emergent setting, loxapine may be an effective medication for managing acute agitation, according to results presented at the American Psychiatric Association Annual Meeting, held May 18-22, 2019, in San Francisco, California.

Researchers conducted a naturalistic, observational, nonrandomized clinical trial to compare the effectiveness of inhaled loxapine 10 mg vs a combination of intramuscular haloperidol 5 mg and lorazepam 2 mg for the management of acute agitation in the emergency department. Baseline agitation was assessed prior to medication and at 15, 30, 45, 60, 90, 120, and 150-minute intervals using the Positive and Negative Syndrome Scale Excited Component. The need for physical restraints was also recorded.

Between March 2017 and December 2018, researchers enrolled 35 patients, 22 in the study group and 13 in the control group. The groups were similar with respect to age, sex, race/ethnicity, and payer status.

Compared with baseline scores, loxapine had a significantly larger decrease in agitation relative to controls by 15 minutes (50% reduction vs 39% in the control group, P =.001). Lower levels of agitation were seen in the test group in nearly all subsequent observations. At baseline, there were 3 control and 2 study participants in restraints. By the 60 minutes observation time, 3 additional control participants required restraints, while both patients in the test group no longer required restraints. Finally, a lower percentage of patients in the study group required subsequent medications for agitation than those in the control group (40.9% vs 46.2%, respectively).

“Relative to intramuscular medications, [inhaled loxapine] may improving calming while allowing for a less invasive route of administration. Further investigation will be needed to uncover additional patient characteristics that may affect response to sedation including underlying psychiatric diagnoses and illicit drug use,” researchers concluded.

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Wilson M, Vilke, G, Simonsen E. Inhaled loxapine versus intramuscular haldol and lorazepam in the management of acute agitation in the emergency department. Poster presented at: American Psychiatric Association Annual Meeting; May 18-22, 2019; San Francisco, CA. Abstract 167.