Injectable second generation antipsychotics and benzodiazepines in combination: safety considerations

For years we’ve combined or alternated injectable benzodiazepines (e.g. Ativan) with injectable first generation antipsychotics (e.g. Haldol) to manage delirium and agitation in hospitalized patients based on the rationale that the pharmacologic properties of one may complement and help minimize adverse effects of the other. The use of second generation antipsychotics in such combinations has become somewhat popular as these agents became available in parenteral form. However, such use has brought to light unanticipated cardiovascular and respiratory safety concerns particularly with Olanzapine (Zyprexa). This has led at least one institution to implement restrictions which are explained, along with a brief review of pertinent literature, in an article in the American Journal of Health-System Pharmacy. The full text is provided via Medscape.