Drug therapy options for acute agitation in pregnant women
| Drug | Initial dosing | Onseta | Major adverse effectsb |
|---|---|---|---|
| Antihistamines | |||
| Diphenhydramine | 25–50 mg PO, IV, or IM every 1–4 hours Maximum 300 mg/day | PO: 15–30 minutes IM, IV: rapid | Sedation, anticholinergic effects |
| First-generation antipsychotics | |||
| Haloperidol | 5–10 mg PO, IV, or IM Maximum 20 mg/day | PO: 2 –6 hours IM, IV: 20–30 minutes | Extrapyramidal effect, dystonia, sedation, neuroleptic malignant syndrome, anticholinergic effects |
| Second-generation antipsychotics | |||
| Olanzapinec | 5–10 mg PO or IM Maximum 20–30 mg/day | PO: 15 minutes to 4 hours IM: 15–30 minutes | Sedation, orthostatic hypotension, extrapyramidal symptoms |
| Ziprasidone | 20 mg IM Maximum 40 mg/day | IM: 15–30 minutes | Sedation, headache, nausea, extrapyramidal symptoms |
| Benzodiazepines | |||
| Lorazepam | 0.5–2 mg PO, IV, or IM | PO: 15–30 minutes IM, IV: rapid | Sedation, respiratory depression |
↵a Based on information in Zun LS. Evidence-based review of pharmacotherapy for acute agitation. Part 1: Onset of efficacy. J Emerg Med 2018; 54(3):364–374. doi:10.1016/j.jemermed.2017.10.011
↵b The US Food and Drug Administration no longer uses the letter-based risk categories. A synthesis of risks and benefits of medications in this table is available at https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-during-pregnancy.
↵c Contraindicated in patients taking a benzodiazepine.
IM = intramuscular; IV = intravenous; PO = by mouth