After many years of national shortage and FDA’s black box warning in 2001 (QT prolongation) droperidol is slowing becoming available.
In 2015, a prospective observational study was published involving ED patients who received droperidol for agitation (acute behavioral disturbance).
Method
- Study period: August 2009 to April 2013 in 6 EDs in Australia
- Intervention: droperidol 10 – 20 mg IM or IV (if available)
- EKG performed within 2 hours of droperidol administration.
- QT was manually measured and plotted against the heart rate on the QT nomogram – if above “at-risk line” = abnormal
Results
- Droperidol was administered in 1,403 ED patients
- EKG available in 1,009 ED patients
- Median age: 34 years (IQR: 25-44)
- Men: 59.9%
Four leading reason for ED presentation
- Alcohol intoxication: 421
- Deliberate or threatened self-harm: 200
- Psychostimulant use: 130
- Mental illness/psychosis: 142
- Median droperidol dose: 10 mg (IQR: 10 to 17.5 mg)
- Abnormal QT interval: 13 (1.3%, 95% CI: 0.3% to 2.3%)
- 7 patient had other potential contributing factors: methadone, escitalopram, Amiodarone or preexisting condition.
- Median time to sedation: 20 min (IQR: 10 to 30 min)
Adverse events
- Desaturation (<90%): 22 (1.6%)
- Airway obstruction: 8 (0.6%)
- Hypotension: 28 (2.0%)
- Extrapyramidal symptoms: 7 (0.5%)
- Arrhythmia: 1 (0.1%)
- Hypoventilation (RR < 12 breaths/min): 4 (0.2%)
- Seizure: 1 (0.1%)
- No adverse events: 1,333 (95.0%)
Conclusion
- Droperidol is a safe sedating agent with no evidence of increased risk for QT prolongation with the doses used.
References
Calver L et al. The safety and effectivenss of droperidol for sedation of acute behavioral disturbance in the emergency department. Ann Emerg Med. 2015;66:230-238.