Management of acute agitation and violence
Serotonin toxicity
Cardiovascular complications
Cerebrovascular complications

Management of acute agitation and violence

Key points:
  • Urgent sedation is a useful technique for management of acutely agitated or violent patients in an emergency setting.
    Strength of evidence: 2 stars

  • A range of drugs may be useful, including droperidol, haloperidol, midazolam and lorazepam.
    Strength of evidence: 2 stars

  • In the doses studied, droperidol produces more rapid sedation than haloperidol and lorazepam.
    Strength of evidence: 2 stars

  • Benzodiazepines and antipsychotics may be used in combination and may be more efficacious than the use of single agents.
    Strength of evidence: 1 star

Serotonin toxicity

Key points:
  • Serotonin toxicity may occur after ingestion of amphetamine derivatives alone or if ingested with other serotonergic agents such as antidepressants.
    Strength of evidence: 1 star

  • Pharmacological agents which antagonise the effects of serotonin such as cyproheptadine and chlorpromazine may have a limited role in attenuating symptoms of toxicity.
    Strength of evidence: 1 star

  • Non-specific agents such as benzodiazepines may assist in reducing muscle rigidity, agitation and seizures.
    Strength of evidence: 1 star
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Cardiovascular complications

Key points:
  • Psychostimulant-related chest pain is a common presentation.
    Strength of evidence: 1 star

  • It is more common after cocaine than amphetamine use but can occur with both.
    Strength of evidence: 1 star

  • Benzodiazepines can be particularly useful.
    Strength of evidence: 2 stars

  • Continued psychostimulant use is associated with an increased risk of subsequent infarction.
    Strength of evidence: 1 star

Cerebrovascular complications

Key points:
  • Use of psychostimulants is a risk factor for several cerebrovascular events.
    Strength of evidence: 1 star

  • Onset of symptoms occurs during or within hours of use.
    Strength of evidence: 1 star

  • Cerebrovascular events occur in patients with little in the way of additional risk factors.
    Strength of evidence: 1 star

  • Management should follow standard procedures with early consideration of angiography.
    Strength of evidence: 1 star