A Cochrane review [Abstract] 1 included 4 studies with a total of 733 patients. All studies included patients with acutely disturbed/aggressive/agitated behaviour secondary to psychotic illnesses such as schizophrenia, schizoaffective disorder, mixed affective disorders, the manic phase of bipolar disorder or a brief psychotic episode, irrespective of age and sex.
Droperidol vs. placebo (1 RCT, N = 227): For the outcome of tranquillisation or asleep by 30 minutes there was a clear difference (RR 1.18, 95% CI 1.05 to 1.31). There was a reduced risk of needing additional medication after 60 minutes for the droperidol group (RR 0.55, 95% CI 0.36 to 0.85). There was no evidence that droperidol caused more cardiovascular arrhythmia (1 RCT, N = 227, RR 0.34, 95% CI 0.01 to 8.31) and respiratory airway obstruction (RR 0.62, 95% CI 0.15 to 2.52) than placebo. For 'being ready for discharge', there was no clear difference between groups (RR 1.16, 95% CI 0.90 to 1.48).
Droperidol vs. haloperidol: For the outcome of tranquillisation or asleep by 30 minutes there was a clear difference (RR 1.01, 95% CI 0.93 to 1.09; (1 RCT, N = 228). There was a reduced risk of needing additional medication after 60 minutes for the droperidol group (RR 0.37, 95% CI 0.16 to 0.90; 2 RCTs, N = 255). There was no evidence that droperidol caused more cardiovascular hypotension (RR 2.80, 95% CI 0.30 to 26.49; 1 RCT, N = 228) and cardiovascular hypotension/desaturation (RR 2.80, 95% CI 0.12 to 67.98; 1 RCT, N = 228) than haloperidol. There was no suggestion that use of droperidol was unsafe. For mental state, there was no clear difference between droperidol and haloperidol (Scale for Quantification of Psychotic Symptom Severity, MD 0.11, 95% CI -0.07 to 0.29; 1 RCT, N = 40).
Droperidol vs. midazolam (1 RCT, N = 153): For the outcome of tranquillisation or asleep by 30 minutes, droperidol was less tranquillising than midazolam (RR 0.96, 95% CI 0.72 to 1.28). As regards the 'need for additional medication by 60 minutes after initial adequate sedation, there was an effect (RR 0.54, 95% CI 0.24 to 1.20). In terms of adverse effects, we found no statistically significant differences between the two drugs for either airway obstruction (RR 0.13, 95% CI 0.01 to 2.55) or respiratory hypoxia (RR 0.70, 95% CI 0.16 to 3.03;). However, the use of midazolam did result in 3 people (out of around 70) needing some sort of 'airway management' with no such events in the droperidol group.
Droperidol vs. olanzapine (1 RCT, N = 221): For the outcome of tranquillisation or asleep by any time point, there were no clear differences between droperidol and olanzapine (e.g. at 30 minutes: RR 1.02, 95% CI 0.94 to 1.11). There was a suggestion that patients allocated droperidol needed less additional medication after 60 minutes (RR 0.56, 95% CI 0.36 to 0.87). There was no evidence that droperidol caused more cardiovascular arrhythmia (RR 0.32, 95% CI 0.01 to 7.88) and respiratory airway obstruction (RR 0.97, 95% CI 0.20 to 4.72) than olanzapine. For 'being ready for discharge', there was no difference between groups (RR 1.06, 95% CI 0.83 to 1.34).
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