Safety of Risperidone for Acute Agitation and Alcohol Intoxication in Emergency Department Patients

Abstract

BackgroundAcute agitation in the setting of alcohol intoxication is commonly encountered in the Emergency Department (ED). In this setting, expert consensus guidelines recommend haloperidol over second-generation antipsychotics due to their limited safety data in alcohol intoxication. ObjectiveThe primary objective was to compare vital sign changes prior to and after risperidone administration between ED patients presenting with alcohol intoxication [ETOH (+)] and without alcohol intoxication [ETOH (−)]. The secondary objective was to assess the effect of benzodiazepine co-administration with risperidone on vital signs. MethodsThis was a retrospective chart review of patients who received oral risperidone for acute agitation at two university EDs between January 1, 2012 and December 31, 2015. Vital signs (oxygen saturation, systolic and diastolic blood pressure, heart rate, and respiratory rate) were compared in patients who had ingested alcohol with those who had not. ResultsThere were 785 patients without evidence of alcohol intoxication who received risperidone in the ED, and 52 patients with alcohol intoxication who received risperidone. Overall, risperidone with and without alcohol intoxication and benzodiazepine administration had no statistically significant effect on vital signs (p = ns for all comparisons). ConclusionThis study suggests that oral risperidone may be a safe option for acute agitation in patients presenting to the ED with alcohol intoxication.