Written by Jacob Altholz
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Oral olanzapine vs. diazepam did not have any statistical difference in successful management of pediatric agitation at one hour in this randomized control trial.
Olanzapine or diazepam: where should you reach?
Agitation is a common and complex problem. We need the best tools to treat it while reducing complications. This randomized control trial evaluated oral olanzapine (n = 176) versus diazepam (n = 172) in pediatric agitation and whether either was more successful at one hour without need for more sedation (primary outcome) or higher rates of adverse events, increased length of stay, or time to ingestion (secondary outcomes). This study used weight-based dosing of 5mg or 10mg if the patient was below or above 40kg, respectively, for both medications. Rate of successful control of agitation at one hour post-randomization without need for additional sedation was assessed using the Sedation Assessment Tool and showed no difference between the groups (adjusted risk difference = 3.6%, p = 0.49). Attempts were made to assess satisfaction in both participants and caregivers, and while assessments did not show strong differences, response rates weren’t as high as hoped. Adverse rates happened in four patients in each group within one hour, all of which were rated as mild and only one of which did not resolve (tachycardia), which may have been unrelated. There were a few moderate adverse events after the first hour and no serious events. The study was open-label, given logistical constraints of randomizing a dissolvable tab (olanzapine) vs. a pill (diazepam) and in acute agitation settings.
How does this change my practice?
I am reassured that neither olanzapine nor diazepam have higher rates of adverse effects and that neither had any serious effects throughout the patient’s course. Often such choices for clinicians are based on personal experience/comfort. Both are viable options, and I would feel comfortable reaching for either, depending on the situation or potential kind of agitation I’m treating.
Source
Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication. Ann Emerg Med. 2025 Feb 14:S0196-0644(25)00017-4. doi: 10.1016/j.annemergmed.2025.01.007. Epub ahead of print. PMID: 39955661
Nice to know that each are equivalent in case there is a contract indication to one or the other or drug shortages