Study protocol for a randomised controlled trial of haloperidol plus promethazine plus chlorpromazine versus haloperidol plus promethazine for rapid tranquilisation for agitated psychiatric patients in the emergency setting (TREC-Lebanon)

Dib, Joseph E.; Adams, Clive E.; Ikdais, Werner Henry; Atallah, Elie; Yaacoub, Hiba Edward; Merheb, Tony Jean; Kazour, Francois; Tahan, Fouad; Haddad, Georges; Zoghbi, Marouan; Azar, Jocelyn; Haddad, Chadia; Hallit, Souheil

Abstract

Background: Agitated and aggressive behaviours are common in the psychiatric setting and rapid tranquilisation is sometimes unavoidable. A survey of Lebanese practice has shown that an intramuscular haloperidol, promethazine and chlorpromazine combination is a preferred form of treatment but there are no randomised trials of this triple therapy.
Methods: This is a pragmatic randomised trial. Setting - the psychiatric wards of the Psychiatric Hospital of the Cross, Jal Eddib, Lebanon. Participants - any adult patient in the hospital who displays an aggressive episode for whom rapid tranquilisation is unavoidable, who has not been randomised before, for whom there are no known contraindications. Randomisation – stratified (by ward) randomisation and concealed in closed opaque envelope by independent parties. Procedure – if the clinical situation arises requiring rapid tranquilisation, medical residents overseeing the patient will open a TREC-Lebanon envelope in which will be notification of which group of treatments should be preferred [Haloperidol + Promethazine + Chlorpromazine (HPC) or Haloperidol + Promethazine (HP)], along with forms for primary, secondary and serious adverse effects. Treatment is not given blindly. Outcome - primary outcome is calm or tranquil at 20 minutes post intervention. Secondary outcomes are calm/tranquil at 40, 60 and 120 minutes post intervention, asleep, adverse effects, use of straitjacket and leaving the ward. Follow-up will be up to two weeks post randomisation.
Discussion: Findings from this study will compare the HPC versus HP combination used in Lebanon’s psychiatry emergency routine practice.
Trial registration: ClinicalTrials.gov NCT03639558. Registration date, August 21, 2018.

Citation

Dib, J. E., Adams, C. E., Ikdais, W. H., Atallah, E., Yaacoub, H. E., Merheb, T. J., Kazour, F., Tahan, F., Haddad, G., Zoghbi, M., Azar, J., Haddad, C., & Hallit, S. (2019). Study protocol for a randomised controlled trial of haloperidol plus promethazine plus chlorpromazine versus haloperidol plus promethazine for rapid tranquilisation for agitated psychiatric patients in the emergency setting (TREC-Lebanon). F1000Research, 8, Article 1442. https://doi.org/10.12688/f1000research.19933.1

• Journal Article Type: Article
• Acceptance Date: Aug 15, 2019
• Online Publication Date: Aug 15, 2019
• Publication Date: Aug 15, 2019
• Deposit Date: Aug 20, 2019
• Publicly Available Date: Aug 21, 2019
• Journal: F1000Research
• Electronic ISSN: 2046-1402
• Publisher: F1000Research
• Peer Reviewed: Not Peer Reviewed
• Volume: 8
• Article Number: 1442
• DOI: https://doi.org/10.12688/f1000research.19933.1
• Public URL: https://nottingham-repository.worktribe.com/output/2452842
• Publisher URL: https://f1000research.com/articles/8-1442/v1
• Additional Information: Referee status: Awaiting Peer Review; Grant Information: The author(s) declared that no grants were involved in supporting this work; Copyright: This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
• Contract Date: Aug 21, 2019