In this section
Diazepam - oral
0.2mg - 0.4mg/kg (Max 10mg/dose if benzodiazepine naive)
Lorazepam - oral
0.5mg - 1mg (
<40kg)1mg - 2.5mg (>40kg)
Olanzapine wafer - sublingual (SL)
2.5mg - 5mg (
<40kg)5mg - 10mg (>40kg)
Midazolam - IM / IV
0.1mg - 0.2mg/kg
Olanzapine - IM
Haloperidol - IM / IV
0.1mg - 0.2mg/kg (Max 5mg/dose, usually 2.5mg - 5mg/dose)
Midazolam / Haloperidol Combination (IM)
Give above doses combined in one syringe
Time to review clinical effect before 2nd med
IM: 10 - 20 mins
IV: almost immediate
Respiratory depression1 and airway compromise, paradoxical reactions4
Oral: 20 - 30 mins
IM: 15 - 30 mins
Respiratory depression1, hypotension, ↑HR.
Do not use if history suggestive of prolonged QTC, Extra-pyramidal reactions2, Neuroleptic Malignant Syndrome3, may reduce seizure threshold
IM/IV: 15 - 30 mins
Oral: 30 - 60 mins
Oral:20 - 40 mins
Respiratory depression1 (unlikely to see immediate complications as longer half lives) and paradoxical reactions4
- More commonly seen with benzodiazepines but can also occur with olanzepine and haloperidol.
reactions - more commonly seen with haloperidol but may be seen with olanzapine after only 1 dose. Reactions include; dystonia, dyskinesia, oculogyric crisis and akathisia (restlessness). Reversible with benztropine.
Syndrome - A rare complication of typical and atypical antipsychotics characterised by hyperthermia, muscle rigidity, autonomic dysfunction and altered mental status. Call hospital emergency team (ie: MET call) if suspected and check serum CK as it is invariably elevated. Immediately inform consultant and
reactions - Administration of a benzodiazepine results in increasing agitation and anxiety as opposed to its normal sedating effect. This is more commonly seen in patients with developmental delay and / or a history of aggressive behaviour.
Benztropine - 0.02mg/kg (Max 2mg/dose) given IV or IM for reversal of dystonic reactions associated with haloperidol and olanzepine. Repeated doses may be required.
Flumazenil - 10 micrograms/kg (Max 200micrograms/dose) repeated at 1 minute intervals prn for up to 5 doses, for reversal of respiratory depression associated with benzodiazepines only. Do not give unless you are sure the
patient is not on long term benzodiazepines. Consider flumazenil infusion if more than 5 doses are required.
Vigilant monitoring, particularly for signs of; airway obstruction, respiratory depression, hypotension and extrapyramidal reactions is mandatory.
Monitoring should be performed in a safe environment within the clinical setting.
Some flexibility in observations is acceptable, so as not to unnecessarily wake or irritate the patient further and to permit sufficient patient rest.
Patient with decreased level of
Patient calm, but alert
Vigilant monitoring, particularly for signs of airway obstruction, respiratory depression, hypotension and extrapyramidal reactions is mandatory.
Document fully in the patient's medical record and medication chart when appropriate:
Last Updated May 2013