Droperidol is a butyrophenone, and is a potent D2 (dopamine receptor) antagonist with some histamine and serotonin antagonist activity. It has a central antiemetic action and is frequently used in the treatment of Postoperative nausea and vomiting in adult doses as low as 0.625 or 1.25 mg.

It has also been used as an anti-psychotic in doses as high as 10mg i.m.

In 2001, the FDA changed the labeling requirements for droperidol injection, to include a so-called "Black Box Warning", citing concerns of QT prolongation and Torsades de pointes. The evidence for this is disputed, with less than 20 reported cases of torsades in 30 years and most of those having received doses in excess of 50mg in a 24-hour period. It appears that the QT-prolongation is a dose-related effect and that in low doses, droperidol is not a significant risk.

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Efficacy of droperidol for the control of combative patients - Tips from Other Journals
From American Family Physician, 9/15/97 by Richard Sadovsky

Chemical restraint is considered more humane and safer than physical restraints for combative patients in the emergency department. Agents currently used include benzodiazepines and neuroleptics. The use of benzodiazepines may be limited by adverse effects including respiratory depression, hypotension and worsening of agitation. Droperidol, a butyrophenone, has good sedative effects with minimal acute dystonic reactions. Rosen and associates conducted a prospective, randomized, double-blind trial to evaluate the efficacy of droperidol for the control of patients in the prehospital setting.

A convenience sample of male patients between 18 and 65 years of age who were combative in the prehospital setting were included in the study. Paramedics gave combative patients either 5 mg of intravenous droperidol or a saline placebo. Forty-six patients were randomized; one half of the patients received placebo and one half received droperidol. Vital signs were measured, and evidence of agitation was quantified using an objective five-point scale. Once the study drug was administered, no other sedating drugs were used. Once the prehospital data sheet was completed, the attending physician in the emergency department broke the blinding code and patients were given further sedation when necessary.

At five minutes after administration, the droperidol group was significantly less agitated than the placebo group. After arrival in the emergency department, 11 patients (48 percent) in the saline group required more sedation, compared with three patients (13 percent) in the droperidol group. There were no instances of serious side effects, and blood pressure rates did not differ significantly between the two groups.

Prehospital providers have few options in managing combative patients. Physical restraints are not desirable and benzodiazepines may cause unwanted side effects, although they may be preferable in patients with acute cocaine intoxication because they may prevent cocaine-induced death and seizures. Droperidol also appears to be more effective than haloperidol for controlling agitation more rapidly and for requiring fewer additional doses of sedatives. Intramuscular administration of droperidol appears to be as effective as intravenous administration. The theoretic concern that neuroleptics may lower the seizure threshold in patients has not been demonstrated.

The authors conclude that droperidol is effective for sedation of combative patients in the prehospital setting without causing significant adverse reactions.

Rosen CL, et al. The efficacy of intravenous droperidol in the prehospital setting. J Emerg Med 1997;15:13-7.

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