From the Guidelines
When Ativan (lorazepam) is not effective for agitation in Parkinson's disease, ziprasidone 20 mg IM is a recommended alternative due to its efficacy in rapidly reducing symptoms of acute agitation with minimal risk of extrapyramidal symptoms 1. Alternative intravenous (IV) or intramuscular (IM) medications for agitation in Parkinson's disease include:
- Ziprasidone 20 mg IM, which has been shown to be effective in reducing symptoms of acute agitation with minimal risk of extrapyramidal symptoms 1
- Droperidol, which has been found to be effective in producing sedation and reducing the need for repeat doses, although its use is problematic due to the potential for dysrhythmias 1 It is essential to avoid haloperidol (Haldol) as it can worsen Parkinson's symptoms by blocking dopamine receptors. Close monitoring for respiratory depression, hypotension, and worsening of Parkinson's symptoms is crucial when administering these medications. The underlying cause of agitation should also be investigated, as it may result from medication side effects, infections, or disease progression. Consulting with both neurology and psychiatry specialists is recommended for optimal management of these complex patients. In terms of safety, ziprasidone 20 mg IM is a preferred option due to its minimal risk of extrapyramidal symptoms and lack of significant QTc interval prolongation 1.
From the Research
Alternative Medications for Agitation in Parkinson's Disease
When Ativan (lorazepam) is not effective for agitation in Parkinson's disease, several alternative intravenous (IV) or intramuscular (IM) medications can be considered:
- Haloperidol: a typical antipsychotic that can be used for rapid tranquillisation, but it may cause extrapyramidal symptoms and has a risk of cardiac arrhythmia and sudden death 2
- Olanzapine: an atypical antipsychotic that can be administered IM for acute agitation, with a faster onset of action and fewer adverse effects compared to haloperidol, but it has been associated with adverse events, including fatalities 3
- Ziprasidone: an atypical antipsychotic that can be administered IM for acute agitation, with a relatively faster onset of action and a lower risk of extrapyramidal symptoms, but it should not be used in patients with known QTc interval-associated conditions 3
- Midazolam: a benzodiazepine that can be administered IM for acute agitation, but it may cause sedation and respiratory depression 4
- Droperidol: a typical antipsychotic that can be administered IM or IV for acute agitation, but it has been associated with a risk of cardiac arrhythmia and sudden death 4, 3
Key Considerations
When selecting an alternative medication, it is essential to consider the patient's medical history, current medications, and potential side effects. The choice of medication should be based on the individual patient's needs and the availability of medications in the treatment setting. Additionally, it is crucial to follow strict prescribing guidelines and monitor patients closely for signs of adverse effects, such as extrapyramidal symptoms, sedation, and respiratory depression 3, 2.