Benzodiazepines for agitation in adults and young people with acute mania

If a benzodiazepine is preferred (see Principles of treatment for agitation in adults and young people with acute mania), use:

1clonazepam 0.5 to 1 mg orally, every 4 hours if required, up to a maximum of 4 mg in 24 hours1. Continue for up to 1 week clonazepam clonazepam clonazepam

OR

1diazepam 5 to 10 mg orally, every 4 hours if required, up to a maximum of 40 mg in 24 hours1. Continue for up to 1 week diazepam diazepam diazepam

OR

1lorazepam 1 to 2 mg orally, every 4 hours if required, up to a maximum of 6 mg in 24 hours1. Continue for up to 1 week2. lorazepam lorazepam lorazepam

When selecting a suitable benzodiazepine dose, consider patient factors, such as level of agitation, body size, age, sex, comorbidities, treatment setting, drug history, previous response to sedative drugs and response to treatment. Modest benzodiazepine doses should be used initially in patients treated in the community, particularly in those who are benzodiazepine naïve.

If the patient remains acutely agitated and at risk of harming themselves or others 30 to 60 minutes after the administration of the benzodiazepine, see Pharmacological management for acute behavioural disturbance in adults or Pharmacological management for acute behavioural disturbance in older people for further advice.

1 Specialists (eg psychiatrists, emergency medicine physicians) may use higher doses (eg those used for acute behavioural disturbance) with monitoring and daily review; hospital admission should be considered.Return
2 Lorazepam tablets can be administered sublingually but bioavailability is lower than when administered orally.Return