Short term control of acutely disturbed or violent behaviour

Benzodiazepines are inappropriate to use in patients aged 65 years and older:

for ≥ 4 weeks (no indication for longer treatment; risk of prolonged sedation, confusion, impaired balance, falls, road traffic accidents; all benzodiazepines should be withdrawn gradually if taken for more than 4 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly)

with acute or chronic respiratory failure i.e. pO2 < 8.0 kPa ± pCO2 > 6.5 kPa (risk of exacerbation of respiratory failure)

if they have a history of falls (sedative, may cause reduced sensorium, impair balance).

 For people with learning difficulties initiate treatment with low doses and titrate cautiously with frequent monitoring for side effects

 Additional resources

 KMPT Rapid Tranquilisation Policy

 Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

 NICE NG10 Violence and aggression: short-term management in mental health, health and community settings

Formulary medications