Are oral medications effective in the management of acute agitation?

Abstract

Background: Current expert guidelines recommend treating agitation with oral medications instead of intramuscular medications if possible. Oral medications are sometimes believed to be inappropriate for the emergency department (ED) as they require patient cooperation and may have a slower onset of action. This review examined published literature for the efficacy of oral agents in agitation.

Clinical question: Are oral medications effective at managing acute agitation?

Methods: Structured review of PubMed of articles in which the first timepoints of evaluation were<24 hours (i.e., the typical timecourse in the ED).

Results: 11 articles included for final analysis. CONCLUSIONS/CLINICAL BOTTOM LINE: Treatment with oral medications is as effective as intramuscular medications in rapidly reducing psychotic agitation in the ED. Their use is thought to pose less risk to both patient and ED staff and is less coercive. There is little to no evidence about the use of oral medications for ED patients with extreme agitation.