droperidol

Absorption: Well absorbed following IM administration. IV administration results in complete bioavailability.

Distribution: Appears to cross the blood-brain barrier and placenta.

Metabolism/Excretion: Mainly metabolized by the liver. Only 10% excreted unchanged by the kidneys.

Half-Life: 2.2 hr.

Time/Action Profile ⬆ ⬇

(sedation)

ROUTE	ONSET	PEAK	DURATION*
IM, IV	3–10 min	30 min	2–4 hr

*Listed as duration of tranquilization; alterations in consciousness may last up to 12 hr.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Known intolerance;
Angle-closure glaucoma;
Bone marrow depression;
CNS depression;
Severe liver or cardiac disease;
Known or suspected QT interval prolongation;
Lactation: Lactation.

Use Cautiously in:

Diabetes;
Respiratory insufficiency;
Prostatic hyperplasia;
CNS tumors;
Intestinal obstruction;
Seizures (may lower seizure threshold);
Concurrent use of benzodiazepines, IV opioids, or volatile anesthetics (may ↑ risk of serious arrhythmias) (use lower initial doses);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Children 2 yr (safety and effectiveness not established);
Geri: risk of serious arrhythmias in older adults (use lower initial doses).

Patients with risk factors for prolonged QT syndrome (HF, bradycardia, diuretic use, cardiac hypertrophy, hypokalemia, hypomagnesemia) or other drugs known to prolong QT interval.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia, QT prolongation, ARRHYTHMIAS (INCLUDING TORSADES DE POINTES)

EENT: blurred vision, dry eyes

GI: constipation, dry mouth

Neuro: extrapyramidal reactions, abnormal EEG, anxiety, confusion, dizziness, excessive sedation, hallucinations, hyperactivity, mental depression, nightmares, restlessness, SEIZURES, tardive dyskinesia

Resp: bronchospasm, laryngospasm

Misc: chills, facial sweating, shivering

Interactions ⬆ ⬇

Drug-drug:

Additive hypotension with antihypertensives or nitrates.
Additive CNS depression with other CNS depressants, including alcohol, antihistamines, antidepressants, opioid analgesics, and other sedatives.
Concurrent use of drugs known to prolong QT interval (↑ risk of potentially life-threatening arrhythmias).

Drug-Natural Products:

Concomitant use of kava-kava, valerian, chamomile, or hops can ↑ CNS depression.

Route/Dosage ⬆ ⬇

IM IV (Adults ): 2.5 mg initially, then additional doses of 1.25 mg may be administered with caution to achieve desired effect.
IM IV (Children ≥2 yr): 0.01–0.075 mg/kg (max = 1.25 mg) initially; administer additional doses with extreme caution and only if potential benefit outweighs risks.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 2.5 mg/mL

Assessment ⬆ ⬇

Monitor BP and heart rate frequently during therapy. Report significant changes immediately. Hypotension may be treated with parenteral fluids if hypovolemia is a causal factor. Vasopressors (norepinephrine, phenylephrine) may be needed. Avoid use of epinephrine, because droperidol reverses its pressor effects and may cause paradoxical hypotension.
- Assess 12-lead ECG in all patients prior to administration to determine if prolonged QT interval is present. Do not administer to patients with a prolonged QT interval. Monitor ECG prior to, during, and for 2–3 hr after treatment to monitor for arrhythmias.
- Assess patient for level of sedation following administration.
- Observe patient for extrapyramidal symptoms (dystonia, oculogyric crisis, extended neck, flexed arms, tremor, restlessness, hyperactivity, anxiety) during therapy. Notify health care professional if these occur. An anticholinergic antiparkinsonian agent may be used to treat these symptoms.
Nausea and Vomiting: Assess nausea, vomiting, hydration status, bowel sounds, and abdominal pain prior to and following administration.

Implementation ⬆ ⬇

Do not confuse droperidol with dronabinol.

IV Administration:

Diluent: Administer undiluted.Concentration: 2.5 mg/mL.
Rate: Administer each dose slowly over 30–60 sec.
Intermittent Infusion: Diluent: May be added to D5W, 0.9% NaCl, or LR.
Rate: Administer by slow IV infusion. Titrate according to patient response.

Patient/Family Teaching ⬆ ⬇

Explain purpose of droperidol to patient.
Caution patient to change positions slowly to minimize orthostatic hypotension.
Medication causes drowsiness. Advise patient to call for assistance during ambulation and transfer.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇