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This is more commonly seen in patients with developmental delay and / or a history of aggressive behaviour.

Benztropine - 0.02mg/kg (Max 2mg/dose) given IV or IM for reversal of dystonic reactions associated with haloperidol and olanzepine. Flumazenil - 10 micrograms/kg (Max 200micrograms/dose) repeated at 1 minute intervals prn for up to 5 doses, for reversal of respiratory depression associated with benzodiazepines only.

Vigilant monitoring, particularly for signs of; airway obstruction, respiratory depression, hypotension and extrapyramidal reactions is mandatory.

Monitoring should be performed in a safe environment within the clinical setting.

Some flexibility in observations is acceptable, so as not to unnecessarily wake or irritate the patient further and to permit sufficient patient rest.

Antihistamines are classified into two groups – the first-generation (“sedating”) and second-generation (“non-sedating”).

Sedating antihistamines cause sedation as they are highly lipid soluble and readily cross the blood brain barrier.

This sedating activity is sometimes used in managing conditions such as eczema where sleep maybe disturbed due to pruritus.

Sedating antihistamines also have significant antimuscarinic activity and should be used with caution in patients with prostatic hypertrophy, urinary retention and angle-closure glaucoma.

Examples of sedating antihistamines: Sedation is rare with non-sedating antihistamines, however patients should be made aware that a sedative effect may occur and performance of skilled tasks such as operating machinery or driving maybe affected.

Extrapyramidal reactions - more commonly seen with haloperidol but may be seen with olanzapine after only 1 dose.

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