Rapid tranquillisation

• Rapid tranquillisation refers to the use of medication by the parenteral route (usually intramuscular or, exceptionally, intravenous) if oral medication is not possible or appropriate and urgent sedation with medication is needed.
• Options:

  • IM Lorazepam on its own - first line
  • IM haloperidol combined with IM promethazine (sedating antihistamine)
• If there is insufficient information to guide the choice of medication for rapid tranquillisation, or the service user has not taken antipsychotic medication before, use intramuscular lorazepam.
• If there is evidence of cardiovascular disease, including a prolonged QT interval, or no electrocardiogram has been carried out, avoid intramuscular haloperidol combined with intramuscular promethazine and use intramuscular lorazepam instead.
• If there is no response to intramuscular lorazepam, consider intramuscular haloperidol combined with intramuscular promethazine.
• Monitoring:

  • Pulse
  • BP
  • Resp rate
  • Temperature
  • Level of consciousness
  • Level of hydration
  • At least every hour or every 15 minutes if maximum dose has been exceeded