Comparison of sublingual and intravenous administration of lorazepam in psychiatric emergencies in emergency medical services

Abstract

Agitation is afrequent reason for emergency physician calls in psychiatric emergencies in the German preclinical emergency medical system. Benzodiazepines have proven to be effective in treating acute agitation. Although lorazepam has beneficial clinical and pharmacological properties it is hardly used by emergency physicians. The sublingual administration of lorazepam has many advantages compared to intravenous administration. In an interventional trial lasting 18months the efficacy, tolerance and onset of effects of sublingual and intravenous lorazepam in patients with agitation states in emergency duties were compared. The randomization to the intervention groups was subject to atime criterion. The sublingual administration of lorazepam over a period of 9months was followed by an intravenous administration over the same period of time. The psychometric scales used were: PANSS-EC, CGI, CGI-Change, agitation-calmness evaluation scale, visual analog scale and sedation scale. Response to the intervention was defined by a40% reduction on the PANSS-EC scale. A total of 37individuals participated in the study (sublingual: n = 22, intravenous: n = 15). Lorazepam was effective in treating acute agitation. The effectiveness and tolerance of sublingual and intravenous lorazepam administration seems to be comparable. Sublingual administration of lorazepam is effective for treating acute agitation in emergency medical services.