This study is a non-inferiority phase III randomized trial evaluating the effect of intranasal midazolam versus intramuscular loxapine on the rapid tranquilization of agitated patient in emergency department. Intranasal midazolam is safe and may allow a management of extreme agitation state and prevent adverse effects.
This study is a prospective, multicenter, open-label randomized, controlled, parallel-group 2-arm phase III non-inferiority trial. Patients with agitation at emergency department will be randomized to two arms of treatment: one experimental arm with intranasal midazolam 5mg (investigational medicinal product), and one control arm with comparator treatment intramuscular loxapine 100mg. The duration of participation for each patient is at least 28 days (+7 days if follow-up not completed on D28). An endpoint Adjudication Committee will be scheduled.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1
Midazolam, 5 mg, injectable solution in 5mg/ml, intranasal administration, atomize into nose with Mucosal Atomizer Device (MAD) 5mg(1ml) up each nostril , one time
Loxapine, 100mg, injectable solution in 50mg/2ml intramuscular, intra muscular administration, one time
Hôpital Avicenne
Bobigny, France
Evolution of agitation
The proportion of patients with sufficient improvement of agitation at 15 minutes defined by a reduction of at least 3 points on the CGI (Clinical Global Impression).
Time frame: 15 minutes
Incidence of adverse events following the use of loxapine or midazolam
The adverse effects over 240 minutes : oxygen desaturation \[\<90%\], airway obstruction requiring intervention, tracheal intubation, cardiac arrhythmias, prolonged QTc interval, hypotension, extrapyramidal side effects, akathisia, and anaphylaxis.
Time frame: 240 minutes
Number of deceased patients
mortality at 24 hours
Time frame: 24 hours
Number, type and severity level of adverse events
The adverse effects over 240 minutes : oxygen desaturation \[\<90%\], airway obstruction requiring intervention, tracheal intubation, cardiac arrhythmias, prolonged QTc interval, hypotension, extrapyramidal side effects, akathisia, and anaphylaxis
Time frame: 240 minutes
level of sedation obtained by loxapine or midazolam.
The proportion of patients with sufficient improvement of agitation at 240 minutes defined by a reduction of at least 3 points on the CGI. Proportion of patients clinically improved on the improvement subscale of the clinical global impressions scale at 15, 60, 120, and 240 minutes.
Time frame: 15,60,120 and 240 minutes
level of sedation obtained by loxapine or midazolam.
Proportion of patients with additional sedation required
Time frame: 15 minutes
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
feelings of health providers with Qualitative research.
Duration of violent and acute behavioural disturbance Staff injuries. Proportion of patients requiring the doctor to be called back.
Time frame: 15 min and 240 min
Improvement of agitation
The proportion of patients with sufficient improvement of agitation at 15 minutes defined by a RASS \< -1
Time frame: 15 min