Acute Agitation

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Course Credit: 1 hour

Treatment of overtly agitated, violent, or psychotic patients in the emergency department is challenging as clinicians often lack information about patients’ past medical and psychiatric history. Further, an agitated patient’s behavior may hinder the ability to perform a clinical examination. When presented with this scenario, verbal de-escalation should be trialed along with easy-to-administer oral medications.1 However, when these low-risk strategies fail, more potent pharmacologic sedation and physical restraints may be required.2 The ultimate decision to pursue pharmacologic sedation is a clinical one with the goal of calming the patient without oversedation so that he/she can take part in the plan of care without compromising diagnostic efforts or causing harm. This Capsules module will discuss the pharmacologic background of various agents used in the treatment of the agitated patient.

Learning Objectives

  1. Describe pharmacokinetic properties of medications routinely used to treat acute agitation
  2. Identify potential adverse effects associated with first- and second-generation antipsychotics
  3. Evaluate the comparative efficacy between various pharmacologic agents for treatment of acute agitation
  4. Recognize potential challenges of pharmacologic sedation in special populations
Jenny Koehl, PharmD, BCPSEmergency Medicine Clinical Pharmacist, Massachusetts General Hospital@jlkoehl
Kyle DeWitt, PharmD, BCPSEmergency Medicine Clinical Pharmacist, University of Vermont Medical Center@EmergPharm
Gabrielle L. Procopio, PharmD, BCPSEmergency Medicine Clinical Pharmacist, Hackensack University Medical Center@gppharmed
Zlatan Coralic, PharmD, BCPSEmergency Medicine Clinical Pharmacist, University of California – San Francisco@ZEDpharm
Emily Wiener, PharmDEmergency Medicine Clinical Pharmacist, Baltimore Washington Medical Center@PharmdEMily
Xander Miller, PharmDPGY-1 Pharmacy Resident, Massachusetts General Hospital@XanderBOS
Bryan Hayes, PharmD, FAACT, FASHP (Lead Editor)Emergency Medicine Clinical Pharmacist, Massachusetts General Hospital@PharmERToxGuy


  1. Gilligan J, Lee B. The psychopharmacologic treatment of violent youth. Ann N Y Acad Sci. 2004;1036:356-381. [PubMed]
  2. Downes M, Healy P, Page C, Bryant J, Isbister G. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. 2009;21(3):196-202. [PubMed]

3 thoughts on “Acute Agitation”

  1. Under the special population section for acute agitation in a pregnant patients the listed second line agent is recommended to be BENZO’s.
    This is category D.
    I understand riks/ benefit but this really boxes us in to use this agent.
    Any comment/advice?
    Thx for nice review/discussion on topic.

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