Clotiapine in the treatment of acutely agitated patients: hardly any evidence
background In Flemish emergency psychiatry, clotiapine is still one of the options available for the treatment of agitation. However, there is a lack of evidence concerning the efficacy of this practice.
aim To find out whether there is sufficient evidence to justify the continued use of clotiapine in the treatment of agitation.
method On searching the literature systematically, we identified controlled trials of clotiapine.
results The efficacy and safety of clotiapine were studied in two randomised controlled trials. Clotiapine (administered intramuscularly) was compared with zuclopenthixol acetate and lorazepam. Clotiapine was found to be just as efficient as the control treatments, causing fewer anticholinergic side-effects than zuclopenthixol but more extrapyramidal side-effects than lorazepam. The study population comprised only 102 patients, 51 of whom were treated with clotiapine. Because the quality of the reported data was low, straightforward conclusions were difficult to draw.
conclusion Scientific evidence to support the use of clotiapine in the treatment of agitation ranges from meagre to practically non-existent. Since alternative treatment options are available, the contained use of clotiapine should be questioned.