Evidence-based review and appraisal of the use of droperidol in the emergency department

Abstract

Droperidol is a short-acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low-dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence-based analysis to appraise high-quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED). Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision-making.

PONV management in patients with QTc prolongation on the EKG

“…There has been a long debate about droperidol related to the black box warning generated by the FDA regarding the risk for TdP ( Kantor, 2002 ; Habib and Gan, 2003 ; Kao et al, 2003 ; Shafer, 2004 ; Charbit et al, 2005 ; Charbit et al, 2008 ; Halloran and Barash, 2010 ; Perkins et al, 2015 ; Tracz and Owczuk, 2015 ; Lai and Huang, 2018 ). It is well known that butyrophenones, including droperidol and haloperidol, increase the QTc, and in some patients such a transient prolongation may trigger TdP or other arrhythmias.…”

“…EKG monitoring and an action plan to promptly treat TdP and other arrhythmias, should they occur, is mandatory. (Charbit et al, 2005;Curigliano et al, 2009;Marbury et al, 2009;Owczuk et al, 2009;Drew et al, 2010;Brygger and Herrstedt, 2014;Chu et al, 2014;Perkins et al, 2015;Tracz and Owczuk, 2015;Täubel et al, 2017;Hellström and Al-Saffar, 2018;Lai and Huang, 2018;Hansen, 2019;Staudt and Watkins, 2019;Berul, 2020;Gan et al, 2020).…”