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Pharmacy/Psychiatric meds


Hello Nigel,

I am an author, and am trying to add some authenticity to a situation in my latest work. Would really appreciate it if you could help:)

You know how in countless films and so forth, when they show an unruly psychiatric patient being subdued and injected in order for the staff to gain control of them? What would the patient be injected with? Thorazine? Benzodiazepine?

And secondly, let's say the patient was under the influence of this drug, and someone who wanted to clear them up real fast injected them with a counter drug, that might also give an adrenaline rush when injected. What drug could this be?  

Thanks so much for your insights!


I'm afraid I'm not the best expert to deal with mental health questions, and you may find one of the other pharmacists or doctors on the panel may be able to give you more useful advice based on current practice (I haven't worked in a mental health setting for over 30 years!). However, hopefully the following thoughts might help you:

- What time period are you setting the story in? Drugs used 30 years ago such as paraldehyde and chlorpromazine (Thorazine) were commonly available and used with moderate success, particularly by injection. In modern times not only are they rarely available at all, but would also be far from a first choice drug. Currently, benzodiazepines are most likely to be the first choice for an immediate effect, moving on to a short-acting, then depot major tranquiliser such as risperidone or olanzapine.

- The route of administration is an issue - oral doses can take at least an hour before they begin to be effective (longer on a full stomach), and is the "patient" co-operative enough to take a drug that way? Otherwise you're looking at injection or rectal administration. Again co-operation or a degree of restraint could be required. Rectal administration is fairly fast acting, but requires the recipient to at least remain face down for a while! Intramuscular injection is perhaps easiest (relatively) to administer, but absorption and onset can be erratic depending on how deep the injection was given and how good the blood supply is. Large volume IM injections are also painful, so the comic vision of a large syringe is definitely not the case! Intravenous administration gives the fastest effect, but needs the ability to access a suitable blood vessel.

- Some of the newer major tranquilisers such as olanzapine and risperidone are also available in oral liquid or melt in the mouth "wafers". If they can be administered and retained, they can be relatively fast acting.

- In such manic episodes, the intention is probably not to render the individual comatose at the first attempt. More reasonably, the intention would be to get enough drug on board to bring the patient down to a more co-operative and manageable state. Following this, other more appropriate treatment options would be introduced.

I may be way, way off target, but I hope this helps.


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Nigel Simmons


I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised. Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner. I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question. Consider.. would you want me to discuss your care with a friend or relative without your knowledge?


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