Two review authors extracted and cross-checked data independently. We calculated fixed-effect relative risks (RR) and 95% confidence intervals (CI) for dichotomous data. We analysed by intention-to-treat. We used mean differences (MD) for continuous variables.
MAIN RESULTS: We found no data for the primary outcome, tranquillisation. Compared with
haloperidol,
zuclopenthixol acetate was no more sedating at two hours (n = 40, 1 RCT, RR 0.60, 95% CI 0.27 to 1.34). People given
zuclopenthixol acetate were not at reduced risk of being given supplementary
antipsychotics (n = 134, 3 RCTs, RR 1.49, 95% CI 0.97 to 2.30) although additional use of
benzodiazepines was less (n = 50, 1 RCT, RR 0.03, 95% CI 0.00 to 0.47). People given
zuclopenthixol acetate had fewer
injections over seven days compared with those allocated to
haloperidol IM (n = 70, 1 RCT, RR 0.39, 95% CI 0.18 to 0.84, NNT 4, CI 3 to 14). We found no data on more episodes of aggression or harm to self or others. One trial (n = 148) reported no significant difference in adverse effects for people receiving
zuclopenthixol acetate compared with those allocated
haloperidol at one, three and six days (RR 0.74, 95% CI 0.43 to 1.27). Compared with
haloperidol or
clotiapine, people allocated
zuclopenthixol did not seem to be at more risk of a range of
movement disorders (< 20%). Three studies found no difference in the proportion of people getting blurred vision/dry mouth (n = 192, 2 RCTs, RR at 24 hours 0.90, 95% CI 0.48 to 1.70). Similarly,
dizziness was equally infrequent for those allocated
zuclopenthixol acetate compared with
haloperidol (n = 192, 2 RCTs, RR at 24 hours 1.15, 95% CI 0.46 to 2.88). There was no difference between treatments for leaving the study before completion (n = 522, RR 0.85, 95% CI 0.31 to 2.31). One study reported no difference in adverse effects and outcome scores, when high dose (50-100 mg/injection)
zuclopenthixol acetate was compared with low dose (25-50 mg/injection)
zuclopenthixol acetate.
AUTHORS' CONCLUSIONS: Recommendations on the use of
zuclopenthixol acetate for the management of psychiatric emergencies in preference to 'standard' treatment have to be viewed with caution. Most of the small trials present important methodological flaws and findings are poorly reported. This review did not find any suggestion that
zuclopenthixol acetate is more or less effective in controlling aggressive acute
psychosis, or in preventing adverse effects than intramuscular
haloperidol, and neither seemed to have a rapid onset of action. Use of
zuclopenthixol acetate may result in less numerous coercive
injections and low doses of the
drug may be as effective as higher doses. Well-conducted pragmatic randomised controlled trials are needed.