DROPERIDOL 
Pronounciation
- (droh-PER-ih-dohl)
Trade Name(s)
- Inapsine
Electrolyte correction indicated; see Precautions. Baseline ECG required; see Monitor.
May cause serious proarrhythmic effects and death; reserve use to patients for whom other treatments are ineffective or inappropriate. Dose should be individualized and initiated at a low dose. Adjust upward, with caution, to achieve the desired effect. Consider age, body weight, physical status, underlying pathologic conditions, use of other drugs, type of anesthesia to be used, and surgical procedure involved; see Precautions. Maximum recommended initial dose is 2.5 mg. Additional 1.25-mg doses may be given to achieve the desired effect but should be used only if the potential benefit outweighs the potential risk.
Prevention of perioperative nausea and vomiting:
Dose should be individualized; maximum initial dose is 2.5 mg by slow IV injection. Additional 1.25-mg doses may be given with caution to achieve desired effect only if benefits outweigh potential risk. 0.625 to 1.25 mg has been shown to have an effect similar to ondansetron (Zofran) 4 mg.
Prevention of perioperative nausea and vomiting, pediatric patients 2 to 12 years:
The maximum recommended dose is 0.1 mg/kg (100 mcg/kg). Another source suggests 0.03 to 0.07 mg/kg/dose (30 to 70 mcg/kg/dose) over 2 minutes or up to 0.1 mg/kg/dose with caution to achieve desired effect only if benefits outweigh potential risk and total dose does not exceed 2.5 mg. May be given IM or IV. See Maternal/Child.
Initiate at a low dose and adjust upward with caution to achieve the desired effect.
■ Reduce dose of narcotics and all CNS depressants to one-fourth or one-third of usual dose before, during, and for 24 hours after injection of droperidol.
■ If other CNS depressants (e.g., narcotics) have been given previously, reduce dose of droperidol.
■ Reduce dose for elderly, debilitated, and poor-risk patients and those with impaired kidney or liver function.
May be given undiluted. Give through Y-tube of the infusion set. May be added to a convenient volume of selected infusion solutions (D5W, NS, or LR).
No data available from manufacturer.
Store vials at CRT; protect from light. Diluted solutions stable at CRT for at least 48 hours (up to 7 days in selected solutions; see literature).
Manufacturer states, “Will precipitate if mixed with barbiturates” (e.g., phenobarbital).
Other sources suggest specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
Adults: 2.5 mg or fraction thereof over 1 to 2 minutes. Pediatric patients: A single dose or fraction thereof over a minimum of 2 minutes.
Titrate by dose and desired patient response. Do not exceed rate for IV injection.
An antianxiety agent that produces marked tranquilization and sedation. Has an antiemetic action also. It produces mild alpha-adrenergic blockade and produces peripheral vascular dilation. May decrease an abnormally high pulmonary arterial pressure. A dose-dependent and significant QT prolongation at all dose levels (0.1, 0.175, and 0.25 mg/kg) has been observed within 10 minutes of administration in patients without known cardiac disease. Effective in 3 to 10 minutes with maximum results in 30 minutes. Lasts 2 to 4 hours. Some effects persist for 12 hours. Metabolized in the liver. Excreted in urine and feces. Crosses placental barrier very slowly. Secreted in breast milk.
To reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures.
Antiemetic in cancer chemotherapy including potent emetic agents (e.g., cisplatin).
■ Treatment of acute psychotic episodes manifested by severe agitation and combativeness.
■ Adjunct to local or general anesthesia.
Known hypersensitivity to droperidol or other butyrophenones (e.g., haloperidol [Haldol]) and patients with known or suspected QT prolongation, including those with congenital long QT syndrome.
Use of agents other than droperidol is recommended.
■ QT prolongation and torsades de pointes have been reported with doses at or below those recommended. Some cases have occurred in patients with no known risk factors for QT prolongation, and some cases have been fatal.
■ Use with extreme caution in patients who may be at risk for development of prolonged QT syndrome (e.g., clinically significant bradycardia [less than 50 bpm]; CHF or any clinically significant cardiac disease; use of a diuretic; treatment with Class Ia antiarrhythmics and/or Class III antiarrhythmics; treatment with MAO inhibitors [e.g., selegiline]; concomitant treatment with other drug products known to prolong the QT interval; electrolyte imbalance, in particular hypokalemia or hypomagnesemia; alcoholism; or concomitant treatment with drugs that may cause electrolyte imbalance or hypovolemia). See Drug Interactions.
■ Other risk factors may include patients over 65 years of age, alcohol abuse, pheochromocytoma, and the use of agents such as benzodiazepines, volatile anesthetics, and IV opiates.
■ Correct hypokalemia and/or hypomagnesemia before administration.
■ When used without a general anesthetic, topical anesthesia is still required when appropriate (e.g., bronchoscopy).
■ May worsen symptoms of Parkinson’s disease.
A potent drug. Obtain a baseline ECG on all patients. Do not administer droperidol if a prolonged QT interval exists (QTc greater than 440 msec for males or 450 msec for females).
■ Monitor VS and ECG closely. Monitor for palpitations, syncope, and/or other symptoms of irregular cardiac rhythm and evaluate promptly.
■ Resuscitation equipment, a narcotic antagonist (if a narcotic has been used concurrently), IV infusion line, IV fluids, and equipment and drugs to manage emergency situations must be readily available.
■ In patients for whom the benefit is believed to outweigh the risks of potentially serious arrhythmias, monitor for arrhythmias during the treatment and for 2 to 3 hours after treatment.
■ Orthostatic hypotension is common; move and position patients with care.
■ EEG pattern may be slow in returning to normal postoperatively. See Precautions.
Avoid activities that require alertness for 24 hours after receiving droperidol.
■ Do not drink alcoholic beverages or take other CNS depressants (e.g., antihistamines, pain medications, sleeping pills) for 24 hours after receiving droperidol.
Category C: safety for use during pregnancy not established; is rarely used. An exception is selected use during cesarean section; it has also been used to treat hyperemesis gravidarum (no longer recommended).
■ Is secreted in breast milk; avoid breast-feeding.
■ Pediatric patients may be more susceptible to extrapyramidal side effects, especially acute dystonic reactions.
■ Safety for use in pediatric patients under 2 years not established.
See Dose Adjustments.
■ More likely to experience hypotension, excessive sedation, and prolonged QT syndrome.
Concurrent use with fentanyl may cause hypotension and decrease pulmonary arterial pressure.
■ May cause precipitous hypotension with epinephrine.
■ Use caution with other CNS depressant drugs (e.g., barbiturates, tranquilizers, opioids, and general anesthetics); may have additive or potentiating effects with droperidol; see Dose Adjustments.
■ Increased risk of QT prolongation and torsades de pointes with other drugs known to increase the QT interval (e.g., Class Ia antiarrhythmics [e.g., disopyramide, procainamide, quinidine] and/or Class III antiarrhythmics [e.g., amiodarone, dofetilide, ibutilide, sotalol], anticonvulsants, antidepressants, antihistamines [e.g., diphenhydramine], antimalarials, antineoplastics, azole antifungal agents, calcium channel blockers, fluoroquinolones, other neuroleptics [e.g., haloperidol, lithium], and many others); see Precautions.
■ Concurrent administration with volatile anesthetics, benzodiazepines, or IV opiates may produce prolonged QT syndrome. Initiate therapy at a low dose and adjust with caution.
■ Concomitant treatment with diuretics, laxatives, steroids with mineralocorticoid potential (e.g., hydrocortisone) may cause hypovolemia and/or induce hypokalemia or hypomagnesemia.
■ Concurrent use with other agents that produce hypotension may cause orthostatic hypotension; risk is increased with agents that produce vasodilation (e.g., amiodarone, milrinone, nitroprusside sodium, nicardipine).
■ See Dose Adjustments and Precautions.
Abnormal EEG, chills, dizziness, hallucinations, hypotension, restlessness, shivering, tachycardia.
Apnea; cardiac arrest; extrapyramidal symptoms; hypotension (severe); neuroleptic malignant syndrome (altered consciousness, muscle rigidity, and autonomic instability); palpitations, syncope, or other symptoms of irregular cardiac rhythm; QT prolongation and torsades de pointes; respiratory depression; ventricular tachycardia; death.
Notify the physician of any side effect. Minor side effects will probably be transient; for major side effects discontinue the drug, treat symptomatically, and notify the physician. Treat hypotension with fluid therapy (rule out hypovolemia) and vasopressors. Phenylephrine may help to counteract the alpha-blocking effects of droperidol. Epinephrine is contraindicated for hypotension. Further hypotension will occur. Treat extrapyramidal symptoms with benztropine mesylate or diphenhydramine. Treat cardiac arrhythmias as indicated (e.g., magnesium sulfate for torsades de pointes, lidocaine for ventricular tachycardia). An increase in temperature, HR, or CO2 production may be symptoms of neuroleptic malignant syndrome or malignant hyperpyrexia. Consider prompt treatment with dantrolene. Resuscitate as necessary.