Loxapine versus haloperidol parenterally in acute psychosis with agitation

Abstract

A comparison of loxapine and haloperidol parenterally in acute psychotic, agitated patients was carried out as a randomized double‐blind trial. The trial covered 15 patients in each group, and the diagnoses were psychogenic psychosis (18 cases) and acute schizophrenia (12 cases). The patients received 25–50 mg loxapine or 2.5–5 mg haloperidol combined with biperiden 2.5–5 mg every 6–12 hours over a 72‐hour period. The average daily dose was 130 mg loxapine or 12 mg haloperidol. Sedation, agitation/excitement and aggressive behavior were scored prior to treatment and at specified time intervals after the first two injections. As far as sedation is concerned a significantly stronger effect and a more rapid onset of action were seen in the loxapine group when compared with the haloperidol group. The differences were most accentuated in cases of acute schizophrenia. Furthermore there was a tendency to a better control of agitation/excitement and aggression in the loxapine group. Scores on Brief Psychiatric Rating Scale and Clinical Global Impression scale showed no significant differences between the two groups. In spite of prophylactic treatment with biperiden, seven of 15 patients in the haloperidol group experienced extrapyramidal side effects. The most frequent side effect in the loxapine group was atypical dizziness. Loxapine i.m. appears to be a valuable drug in cases of acute psychosis where strong sedation as well as strong antipsychotic effect are necessary for behavioral control.