Benzodiazepines are mainstay medicines in rapid tranquillisation. Midazolam is a short acting benzodiazepine. It is not available for oral administration as this route of administration leads to poor bioavailability. It has recently become available in a new formulation specifically designed for buccal administration, and is also available as a solution for injection.

The absorption of intramuscular midazolam is erratic and it has an unpredictable propensity for causing profound oversedation. Healthcare providers who include IM midazolam in their rapid tranquillisation guidelines or policies need to ensure that clinicians using it have the necessary knowledge, skills and competencies surrounding its use including clinical sequelae and the use of the ‘antidote’ flumazenil.

This brief review describes midazolam's potential role in rapid tranquillisation via these routes, and discusses the risks and benefits of these options in order to help readers consider their places in regular clinical practice, particularly in light of the shortage of lorazepam injection.

Loxapine has recently been licensed in the UK for the management of mild-to-moderate agitation in adults with schizophrenia or bipolar affective disorder.

Loxapine is a first generation antipsychotic, and although not previously available in the UK, it has been used orally and as an intramuscular injection in some countries for many years. It is now formulated in a single use inhalator.

This is the first newly licensed medicine in the UK for the management of agitation for over five years.

This brief article provides an overview of this new medicine in order to help readers consider its place in regular clinical practice prior to its UK launch.