Objective: To determine whether patients with parkinsonism and severe agitation while inpatient have better outcomes when treated with parenteral benzodiazepines instead of parenteral antipsychotics.

Background: Delirium is a particular problem for patients with parkinsonism (PWP) while inpatient and can be severe enough to result in acute agitation warranting treatment with parenteral medications. Frequently used treatments for patients that do not have parkinsonism include intravenous (IV) and intramuscular (IM) haloperidol and IM olanzapine. However, these medications can worsen motor symptoms in PWP, so a widely used alternative is IV benzodiazepines. To our knowledge, the outcomes of using IV benzodiazepines to treat acute agitation in PWP as an alternative to parenteral haloperidol or olanzapine has not been formally studied.

Method: Patients included in the study were hospitalized at the Cleveland Clinic Main Campus or Fairview Hospital between January 1, 2018 and December 31, 2018. Patients with any form of neurodegenerative parkinsonism, including atypical parkinsonism, who received at least one dose of a parenteral antipsychotic or benzodiazepine for agitation were included in the study.  Outcomes included duration of hospitalization, 30-day unplanned readmission rate, and 90-day mortality. Age and age-adjusted Charlson comorbidity index were evaluated as potential confounders.

Results: During the 12-month study period, 492 patients were admitted 725 times. Of these, 33 patients received parenteral antidopaminergic medications, 8 received parenteral benzodiazepines, and 8 received both for acute agitation.  The median (IQR) duration of hospitalization for those who received only parenteral antidopaminergic medications was 7.44 (4.7, 11.17) days and for those who received only parental benzodiazepines was 3.53 (2.15, 6.34) days; and this difference was statistically significant (p-value 0.025). There was no association between parenteral medication of choice and 30-day unplanned readmission rate or 90-day mortality.

Conclusion: Although commonly recommended, IV benzodiazepines have not been studied as an alternative to parenteral antipsychotics for treating acute agitation in PWP. Our preliminary data supports this practice as we have seen a shorter hospitalization stay in patients treated with IV benzodiazepines.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/outcomes-in-patients-with-parkinsonism-treated-for-acute-agitation-with-intravenous-benzodiazepines-compared-to-parenteral-antipsychotics-while-inpatient/