Therapeutic Handbook - GGC Prescribing

Pharmacological Management – Patients with Delirium (< 65 years)Before prescribing see previous page for cautions / contraindications / dose administration advice(take into account frailty when considering total daily dose)• Haloperidol oral 0.5 - 1 mg or if oral not possible:Haloperidol 0.5 - 1 mg initially as single IM dose (preferred route), reassess after 1 hour anddiscuss need for repeat dosing with senior staff. Repeat 1 - 2 mg if necessary, to maximum5 mg.• Olanzapine oral 2.5 – 5 mg (maximum combined oral / IM dose 20 mg in 24 hours). If oralnot possible:Olanzapine 2.5 – 5 mg initially as a single IM dose, reassess after 1 hour and discuss needfor repeat dosing with senior staff. Repeat 5 – 10 mg if necessary up to a maximum of 20mg in 24 hours.NB: Olanzapine IM licensed for short-term use; maximum three IM doses daily for a maximumduration of three days.Alternative only if haloperidol and olanzapine are inappropriate:• Lorazepam oral 0.5 - 1 mg or*Lorazepam IV 12 - 15 micrograms/kg over 2 - 3 minutes into a large vein(50 kg = 0.7 mg, 80 kg = 1.1 mg) at a maximum rate of 2 mg/minute.Or if oral or IV not possible *Lorazepam IM 12 - 15 micrograms/kg.Pharmacological Management – Severely disturbed patients (but notelderly and no co-morbidities)Before prescribing see previous page for cautions / contraindications / dose administration advice• Lorazepam oral 1 - 4 mg (N.B. Higher oral doses may be required for patients tolerant tobenzodiazepines.) Or*Lorazepam IV 25 - 30 micrograms/kg over 2 - 3 minutes into a large vein(50 kg = 1.4 mg, 80 kg = 2.2 mg) at a maximum rate of 2 mg/minute.Or if oral or IV not possible: *Lorazepam IM 25 - 30 micrograms/kgOr (only if lorazepam is not available):Diazepam (Diazemuls ® ) IV 2 - 5 mg into a large vein with 2 - 5 mg increments, if required,to a maximum of 10 mg (maximum rate 5 mg/minute).• Haloperidol oral 1.5 - 3 mg or if oral not possible:Haloperidol IM 2 - 10 mg IM to a maximum total dose of 18 mg in 24 hours*Lorazapam IV / IM: Previously there have been supply issues with IV lorazepam – seek advice frompharmacy if unable to obtain. When given by IM injection it should always be diluted 1:1 immediatelybefore administration with water for injection or sodium chloride 0.9% as it is quite viscid when takenout of the fridge.Central Nervous SystemContinues on next pagePage 169