Hallucinogen Toxicity Medication

Updated: Aug 15, 2018
  • Author: Joseph L D'Orazio, MD, FAAEM; Chief Editor: Sage W Wiener, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Agents that may prove helpful include benzodiazepines and traditional antipsychotics.

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Sedatives

Class Summary

Decrease agitation or combative behavior when patients are at risk of harming themselves or others.

Lorazepam (Ativan)

Sedative hypnotic with fairly rapid onset of effects (15-20 minutes) and relatively long half-life.

By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation.

Haloperidol (Haldol)

Completely blocks postsynaptic dopamine receptors. Drug of choice for patients with acute psychosis when no contraindications are present. Has high potency and low potential for causing orthostasis. Downside is the high potential for extrapyramidal symptoms/dystonia, lowering of the seizure threshold, and QT-interval prolongation..

Parenteral dosage form may be admixed in syringe with 2-mg lorazepam for better anxiolytic effects.

Diazepam (Valium)

Depresses all levels of CNS (eg, limbic and reticular formation) by increasing activity of GABA.

Individualize dosage and increase cautiously to avoid adverse effects. Absorption is unpredictable with intramuscular administration, so should be used intravenously when possible.

Midazolam (Versed)

Sedative hypnotic with rapid onset and relatively short duration of effects.

By increasing the action of gamma-aminobutyric acid (GABA), which is a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

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