An emergency room receives a 40-year-old male, acutely agitated and combative, brought by police. He is unable to provide history. The MOST appropriate first step in pharmacological management of undifferentiated acute agitation is:

• A IV haloperidol 5 mg alone
• B Oral or IM lorazepam 2 mg, with IV access secured
• C Droperidol 5 mg IV
• D Combination IM haloperidol + IM promethazine (or lorazepam) ✓

Explanation

Current evidence-based protocols for acute undifferentiated agitation favour combination IM therapy: haloperidol (antipsychotic) combined with either promethazine or lorazepam (benzodiazepine). This combination achieves faster tranquillisation, allows lower doses of each agent, and reduces EPS risk compared to haloperidol alone. Droperidol is effective but requires QTc monitoring. IV haloperidol alone is slower-acting for acute agitation. The combination approach is endorsed by TRASA (Treatment of Acute Agitation) guidelines and international consensus.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.