Droperidol (Systemic)


VA CLASSIFICATION
Primary: CN206
Secondary: GA609; CN709

Commonly used brand name(s): Inapsine.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Anesthesia, adjunct—

antiemetic—

antipsychotic—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

General considerations
Most of the adult patients included in published clinical trials of droperidol for prophylaxis of postoperative nausea and vomiting were women {06} {07} {08} {09} {10} {11} {12} {13} {14} {15} {16} {17} {18}. Many of the trials involved gynecologic surgery {06} {07} {09} {10} {11} {12} {13} {14} {15} {16} {17} {18}. In these trials, droperidol was superior to placebo and usually equal to ondansetron in preventing postoperative nausea and vomiting. High-dose droperidol (i.e., 2.5 mg) was found to be superior to ondansetron (8 mg) in preventing postoperative nausea and vomiting in one trial; however, the patients receiving high-dose droperidol experienced increased sedation and delayed arousal compared to those receiving ondansetron {14}. The degree to which these findings can be generalized to other types of surgery and male patients is not clear.

Most published trials in pediatric patients administered droperidol for prophylaxis of postoperative nausea and vomiting were placebo-controlled trials in strabismus surgery {19} {20} {21}. Although droperidol was more effective than placebo, these studies did not establish the role of droperidol as compared to other antiemetic agents. In one trial in pediatric patients undergoing tonsillectomy, ondansetron was more effective than droperidol in preventing postoperative nausea and vomiting {22}.

Although droperidol is not approved by the FDA to control severe agitation and combativeness, it can be used for this indication {23} {24} {27} {29} {30} {31}. Compared to haloperidol, droperidol is more sedating and controls agitation more quickly {27}. Some, but not all, USP medical experts do not regard droperidol as first-line therapy for this indication {79}.

Although droperidol has been used{82} as an adjunctive agent in anesthesia, some USP medical experts do not regard droperidol as a first-line choice for use in anesthesia {79}. When droperidol is used as an adjunctive agent in anesthesia, USP medical experts recommend lower doses than those indicated in the drug labeling {77}.

Accepted

[Anesthesia, general, adjunct or]{82}
[Anesthesia, local, adjunct]{82}—Droperidol is indicated for use in anesthesia as premedication and for adjunctive use in the induction and maintenance of general and regional anesthesia {01} {02} {03} {34} {36}. Droperidol combined with an opioid analgesic induces neuroleptanalgesia to produce tranquility and decrease anxiety and pain {01} {02} {03}.

Nausea and vomiting (prophylaxis)—Droperidol is indicated to reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures.{81}{01} {02} {03} {06} {07} {08} {09} {10} {11} {12} {13} {14} {15} {16} {17} {18} {35} {39} {40} {42} {46} {49}
—Droperidol is effective in controlling postoperative nausea and vomiting in children undergoing strabismus repair {19} {20} {21} {44}.
—Droperidol has been used as part of a regimen to control nausea and vomiting associated with emetogenic chemotherapy {33} {43} {50}; however, droperidol is considered to be only moderately effective in preventing chemotherapy-associated nausea and vomiting {50}.

[Sedation, conscious]{82}—Droperidol is indicated to produce sedation without loss of consciousness in patients undergoing various diagnostic procedures {01} {02} {03} {32} {52}.

[Psychotic disorder (treatment)]1—Droperidol is indicated in the treatment of acute psychotic episodes manifested by severe agitation and combativeness (Evidence rating: I) {23} {24} {27} {29} {30} {31} {51} {54} {55}. In a comparative study with haloperidol, intramuscular administration of 5 mg of droperidol provided more rapid control of symptoms than an equal dose of haloperidol, without an increase in adverse effects {27}.

Unaccepted
Droperidol has been used in the treatment of Meniere's disease, but it has been replaced by safer and more effective agents.

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:

Chemical group—
    A butyrophenone neuroleptic, chemically related to haloperidol {02}.
Molecular weight—
    379.44 {04}


pH
    Saturated solution at ambient temperature: 7 {02}.
    Droperidol injection has lactic acid added to the formulation to adjust the pH to 3 to 3.8 {02}.

pKa—
    7.64 {05}

Solubility
    Practically insoluble in water; slightly soluble in methanol and ethanol {02}.

Partition coefficient
    The log-partition coefficient (n-octanol/aqueous buffer at pH 9.9) is 3.58 {02}.

Mechanism of action/Effect:

The mechanism of action of droperidol is not known. It has been theorized that droperidol may bind postsynaptic gamma-aminobutyric acid (GABA) receptors. Binding of GABA receptors in the chemoreceptor trigger zone (CTZ) may be the mechanism by which droperidol produces an antiemetic effect {02} {56}. Droperidol may block dopaminergic receptors in the caudate nucleus and in the nucleus accumbens {02}.


Other actions/effects:

Droperidol selectively blocks postsynaptic alpha-adrenergic receptors. This action may cause vasodilation and hypotension {59}.

Droperidol causes a dose-dependent prolongation of the QT interval and has been associated with cases of serious arrhythmias (e.g., torsades de pointes){82}.

Absorption:

Completely absorbed after intramuscular administration {02} {48}.

Distribution:


Volume of distribution at steady state (Vol D SS):


Adults—

1.5 L per kg of body weight (L/kg) {62}.



Children—

0.58 L/kg {57}.



Biotransformation:

Extensively metabolized {48}.

Half-life:


Distribution:

Droperidol has biphasic distribution. The rapid distribution phase is 1.4 ± 0.5 minutes and the slower distribution phase is 14.3 ± 6.5 minutes {63}.



Elimination:

Adults: 134 ± 13 minutes; may be increased in geriatric patients {48}.

Children: 101.5 ± 26.4 minutes {57}.


Onset of action:

3 to 10 minutes {01} {02}.

Time to peak effect:

Within 30 minutes of administration {01} {02}.

Duration of action:

The duration of the sedative effects is 2 to 4 hours {01} {02}, although alteration of alertness may persist for up to 12 hours {01} {02}.

Elimination:


Renal—
        About 75% of intramuscularly administered droperidol is excreted in the urine; only 1% is excreted unchanged {48}.



Biliary/fecal—
        22% of intramuscularly administered droperidol is excreted in the feces; the high fraction of droperidol excreted in the feces suggests biliary excretion {48}.



Precautions to Consider

Cross-sensitivity and/or related problems

Patients sensitive to other butyrophenones may be sensitive to droperidol also.

Carcinogenicity

Carcinogenicity studies have not been done with droperidol {01}.

Mutagenicity

The micronucleus test in female rats revealed no mutagenicity after single doses of up to 160 mg per kg of body weight {01}.

Pregnancy/Reproduction

Pregnancy—
Droperidol has been used in pregnant patients to manage hyperemesis gravidarum {64}. Compared to the control group, the mean birth weight and the incidence of premature birth were not different in the neonates born to droperidol-treated mothers {64}. A similar number of congenital anomalies occurred in the two groups {64}.

FDA Pregnancy Category C {01}.


Labor and delivery—

Droperidol has been used in patients undergoing cesarean section {09}. Respiratory depression in the neonates has not been reported {09}.

Breast-feeding

Droperidol is distributed into breast milk {02}. Although problems in humans have not been documented, the manufacturer recommends breast-feeding be avoided in patients using droperidol {02}.

Pediatrics

Although patients under 2 years of age have been included in some clinical trials {28}, no information is available on the relationship of age to the effects of droperidol in these pediatric patients; safety and efficacy have not been established {01} {02}.

The comparative incidence of extrapyramidal effects from droperidol in pediatric patients as compared to adult patients is not known. However, pediatric patients are more likely than adult patients to experience extrapyramidal reactions after receiving haloperidol. It is expected that pediatric patients may be more likely than adult patients to experience extrapyramidal effects from droperidol also {77}. Of the extrapyramidal effects, acute dystonic effects are more likely in pediatric patients {78}.


Geriatrics


Geriatric patients may be more sensitive to the sedating effects of droperidol; in addition, geriatric patients may be more likely to experience hypotension and prolonged QT syndrome.{81} {01} {02}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

» Anesthetics, volatile or
» Benzodiazepines or
» Diuretics or
» Opiates, intravenous    (Prolonged QT syndrome may occur; initiate at a low dose and adjust upward with caution.{81})


Anesthetics, parenteral-local    (peripheral vasodilation and hypotension due to sympathetic blockade may occur {01})


Bromocriptine or
Levodopa    (dopamine agonists may be inhibited by droperidol {02})


Central nervous system (CNS) depression–producing medications (see Appendix II ), including medications commonly used for anesthesia and analgesia    (additive CNS depression may occur; lower doses may be needed {01} {02})


Epinephrine    (droperidol may antagonize the pressor effects of epinephrine, and may trigger a hypotensive episode {01})


Extrapyramidal reaction–causing medications, other (see Appendix II )    (may increase the frequency and severity of extrapyramidal effects {01})


Hypotension-producing medications (see Appendix II {01} )    (orthostatic hypotension may occur {01}; hypotension is especially likely if droperidol is used concurrently with drugs causing vasodilation )


Propofol    (droperidol may compete with propofol for binding sites in the chemoreceptor trigger zone; concurrent use of propofol and droperidol to control nausea and vomiting is less effective than using propofol alone {70})



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With physiology/laboratory test values
» Electrocardiogram    (droperidol may cause prolongation of the QT interval and torsades de pointes{81}. {53})


Prolactin, serum    (droperidol causes dose-dependent increase in serum prolactin {72})


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problems exist:

Note: Due to its potential for serious proarrhythmic effects and death, droperidol should be reserved for treatment of patients who fail to show an acceptable response to other adequate treatments, either because of insufficient effectiveness or the inability to achieve an effective dose due to intolerable adverse effects from those drugs.{81}

» Hypokalemia or
» Hypomagnesemia or
» QT interval prolongation, pre-existing    (risk of arrhythmia, rarely including sudden death, may be increased {02}
Note:  Cases of QT prolongation and/or torsades de pointes have been reported in patients receiving droperidol at doses at or below recommended doses. Some cases have occurred in patients with no known risk factors for QT prolongation and some cases have been fatal. Droperidol is contraindicated in patients with known or suspected QT prolongation, including patients with congenital long QT syndrome.{81}

)


» Hypersensitivity to droperidol {45} {47} {65}
» Pheochromocytoma    (hypertension and tachycardia may occur {74})


Risk-benefit should be considered when the following medical problems exist
» Alcoholism, acute or
» Bradycardia or
» Cardiac hypertrophy or
» Congestive heart failure or
» Elderly (over 65 years of age){81}    (risk of QT prolongation and torsades de pointes{81}, rarely including sudden death, may be increased, even at doses at or below recommended doses.{81}{02})


Cardiovascular function impairment or
Epilepsy or
Mental depression, severe or
» Parkinsonism    (may worsen condition {02})


Hepatic function impairment    (metabolism may be altered {01})


Hypovolemia    (risk of hypotension may be increased {01} {02})



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Blood pressure and
Body temperature and
Heart rate and
Respiratory and ventilatory status    (routine monitoring of vital signs is recommended {01})


» Electrocardiogram    ( The manufacturer recommends that all patients should undergo a 12–lead electrocardiogram prior to administration of droperidol to determine if a prolonged corrected QT (QTc) interval is present. QTc intervals greater than 440 milliseconds for males or 450 milliseconds for females are prolonged.{83} However, a consensus of USP experts disagree with the recommendation that all patients should undergo a 12–lead electrocardiogram prior to the administration of droperidol.{84} Electrocardiogram monitoring should be performed prior to treatment and continued for two to three hours after completing treatment to monitor for arrhythmias.{81})


Motor functioning    (recommended to monitor for extrapyramidal effects {01} {80})




Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent
    
Akathisia {38} {66} {67} {68} {69} ( restlessness)—extrapyramidal reaction
    
anxiety {67} {68} —extrapyramidal reaction
    
hypertension (high blood pressure)—asymptomatic

Note: Hypertension has occurred following the use of droperidol combined with an opioid analgesic (e.g., fentanyl) and may be due to surgical stimulation during light anesthesia {02}.


Incidence rare
    
Dystonia {25} {37} {67} (spasm of the muscles of the tongue, face, neck, and back)— extrapyramidal reaction
    
hyperpyrexia {02} {73} {76} (fever)— may indicate neuroleptic malignant syndrome
    
oculogyric crisis {25} (fixed upward position of eyeballs)—extrapyramidal reaction
    
QT syndrome, prolonged (irregular or slow heart rate; fainting; sudden death)
{81}


Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
    
Hypotension (lightheadedness)—usually transient
    
excessive sedation {01} {02} (drowsiness)
    
tachycardia (rapid heart rate)



Those indicating possible extrapyramidal reaction and the need for medical attention if they occur after medication is discontinued
    
Akathisia {38} {66} {67} {68} {69} ( restlessness)
    
dystonia {25} {37} {67} (spasm of the muscles of the tongue, face, neck, and back)
    
oculogyric crisis {25} ( fixed upward position of eyeballs)

Note: Dystonia has been reported up to 30 hours after administration of a dose of droperidol {25} {41} {75}.





Overdose
For specific information on the agents used in the management of droperidol overdose, see:    • Benztropine in Antidyskinetics (Systemic) monograph;
   • Diphenhydramine in Antihistamines (Systemic) monograph; and/or
   • Phenylephrine in Sympathomimetic Agents—Cardiovascular Use (Parenteral-Systemic) monograph.

For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Acute and/or chronic
    
Akathisia {01} {02} {03} (restlessness)
    
dystonia {01} {02} {03} (spasm of the muscles of the tongue, face, neck, and back)
    
hypotension {01} {02} {03} (dizziness)
    
prolongation of QT interval {53} {61} —usually asymptomatic
    
oculogyric crisis {01} {02} {03} (fixed upward position of eyeballs)
    
respiratory depression {01} {02} {03} (slowed breathing)


Note: Akathisia, dystonia, and oculogyric crisis are effects that can occur with overdose of droperidol. However, these effects can also occur with usual therapeutic doses of droperidol.


Treatment of overdose
Discontinue droperidol.

Specific treatment—Extrapyramidal reactions (e.g., akathisia, dystonia, and oculogyric crisis) may be treated with anticholinergic agents such as benztropine or diphenhydramine {01} {02}.

Supportive care—A patent airway must be maintained, and respiration should be assisted or controlled if necessary {01}. Oxygen should be administered. Blood pressure should be supported as needed {01}. Phenylephrine may be needed to counteract the alpha-blocking effects of droperidol. In hypovolemic patients, administration of intravenous fluids may be required {01}. Patients in whom intentional overdose is confirmed or suspected should be referred for psychiatric consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Droperidol (Systemic) .
In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Hypersensitivity to droperidol





Breast-feeding—Temporary discontinuation of breast-feeding is recommended in patients receiving droperidol, because droperidol is distributed into breast milk





Use in children—Children may be more likely than adult patients to experience extrapyramidal effects






Use in the elderly—Older patients may be more likely to experience drowsiness , hypotension and prolonged QT syndrome.
Other medical problems, especially acute alcoholism, bradycardia, cardiac hypertrophy, congestive heart failure, hypokalemia, hypomagnesemia, parkinsonism, pheochromocytoma or pre-existing QT interval prolongation

Proper use of this medication

» Proper dosing

Precautions after receiving this medication
Not driving or operating machinery for 24 hours after receiving droperidol

Not drinking alcohol or taking CNS depression–producing medications for about 24 hours after receiving droperidol


Side/adverse effects
Signs of potential side effects, especially akathisia, anxiety, hypertension, dystonia, hyperpyrexia, oculogyric crisis and prolonged QT syndrome.


General Dosing Information
Geriatric, debilitated, or critically ill patients are more likely to experience excessive sedation prolonged QT syndrome{81} and hypotension from the use of droperidol. It is recommended that the initial dose be lower in these patients {01} {02} {03}. Subsequent doses may be titrated based on the response to the initial dose.

Droperidol should not be administered as the sole agent for anesthesia induction for surgery {01}.


Parenteral Dosage Forms

Note: Dosage should be individualized. Some of the factors to be considered in determining the dose are age, body weight, physical status, underlying pathological condition, use of other drugs, type of anesthesia to be used and the surgical procedure involved.{81}


Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

DROPERIDOL INJECTION USP

Usual adult and adolescent dose
[Anesthesia, general, adjunct or]
[Anesthesia, local, adjunct]
{82}

Premedication:
Intramuscular, 2.5 {81} thirty to sixty minutes before surgery. {01} {02} {03} {77}The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk{81}. However, caution is indicated due to the potential for adverse psychotic effects.{85}



Induction:
Intravenous or intramuscular{81}, 1.25 mg per twenty to twenty-five pounds of body weight (0.1 to 0.14 mg [100 to 140 mcg] per kg of body weight) {77}. The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk.{81}



Maintenance:
Intravenous, 1.25 to 2.5 mg {01} {02} {03} {77}. When droperidol is used as an adjunct to regional anesthesia, 2.5 may be administered intramuscularly or intravenously if additional sedation is required. The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk{81} {01} {02} {03}.


Nausea and vomiting, postoperative (prophylaxis)
Intravenous, 7 to 20 mcg per kg of body weight. {07} {08} {09} {10} {11} {12} {13} {14} {15} {16} {17} {18} {26}The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk{81}.

Sedation, conscious
Intramuscular, 1.25 thirty to sixty minutes prior to a diagnostic procedure {01} {02} {03}. The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk.{81}

[Psychotic disorder]1
Intramuscular or intravenous, 2.5 for acute agitation {23} {24} {27} {29} {30} {31}. The dose should be based on the size of the patient and the degree of agitation. The maximum recommended initial dose is 2.5 mg intramuscularly or slow intravenously. Additional 1.25 mg doses may be administered with caution to achieve the desired affect only if the potential benefit outweighs the potential risk.{81}


Usual pediatric dose
[Anesthesia, general, adjunct or]
[Anesthesia, local, adjunct]
{82}

Premedication:
Intramuscular or intravenous, 0.075 to 0.15 mg (75 to 150 mcg) per kg of body weight thirty to sixty minutes before surgery {01} {02} {03}For children 2 to 12 years of age, the maximum recommended initial dose is 0.1 mg per kg of body weight. Additional doses should be administered with caution and only if the potential benefit outweighs the potential risk.{81}.



Induction:
Intravenous, 0.075 to 0.15 mg (75 to 150 mcg) per kg of body weight {01} {02} {03}. For children 2 to 12 years of age, the maximum recommended initial dose is 0.1 mg per kg of body weight. Additional doses should be administered with caution and only if the potential benefit outweighs the potential risk.{81}


Nausea and vomiting, postoperative (prophylaxis)
Intramuscular or intravenous, 0.02 to 0.075 mg (20 to 75 mcg) per kg of body weight. {19} {20} {21} {28} {44} {58} {60}For children 2 to 12 years of age, the maximum recommended initial dose is 0.1 mg per kg of body weight. Additional doses should be administered with caution and only if the potential benefit outweighs the potential risk.{81}.


Usual geriatric dose
See Usual adult and adolescent dose . However, initial doses should be decreased for geriatric patients because geriatric patients are more likely to experience hypotension and excessive sedation after receiving droperidol {01} {02} {03}.

Strength(s) usually available
U.S.—


2.5 mg per mL (Rx) [Inapsine{01}][Generic]{03}

Note: The 10-mL multidose vials available generically contain 1.8 mg of methylparaben and 0.2 mg of propylparaben per mL {03}.


Canada—


2.5 mg per mL (Rx) [Inapsine{02}]

Packaging and storage:
Protect from light. Store between 15 and 30 ºC (59 and 86 ºF) {01} {02} {03}.

Preparation of dosage form:
Droperidol may be diluted to a convenient volume with 5% dextrose injection, 0.9% sodium chloride injection, or lactated Ringer's injection {71}.



Developed: 05/21/1998
Revised: 01/29/2002



References
  1. Inapsine package insert (Akorn—US), Rev 2/96, Rec 2/97.
  1. Inapsine product monograph (Janssen Pharmaceutica—Canada), Rev 10/95, Rec 9/97.
  1. Droperidol package insert (Astra—US), Rev 1/97, Rec 6/97.
  1. Canada JR, editor. USP dictionary of USAN and international drug names 1998. Rockville, MD: The United States Pharmacopeial Convention, Inc; 1997. p. 258.
  1. Budavari S, editor. Merck index 1989. Rahway, NJ: Merck & Co., Inc; 1989. p. 542.
  1. Cozanitis D, Asantila R, Eklund P, et al. A comparison of ranitidine, droperidol, or placebo in the prevention of nausea and vomiting after hysterectomy. Can J Anaesth 1996; 43: 106-9.
  1. Fujii Y, Tanaka H, Toyooka H. Prevention of postoperative nausea with granisetron: a randomized, double-blind comparison with droperidol. Can J Anaesth 1995; 42: 858-6.
  1. Steinbrook R, Freiberger D, Gosnell J, et al. Prophylactic antiemetics for laparoscopic cholecystectomy: ondansetron versus droperidol plus metoclopramide. Anesth Analg 1996; 83: 1081-3.
  1. Pan P, Moore C. Intraoperative antiemetic efficacy of prophylactic ondansetron versus droperidol for cesarean section patients under epidural anesthesia. Anesth Analg 1996; 83: 982-6.
  1. McKenzie R, Lim Uy N, Riley T, et al. Droperidol/ondansetron combination controls nausea and vomiting after tubal banding. Anesth Analg 1996; 83: 1218-22.
  1. Paxton L, McKay A, Mirakhur R. Prevention of nausea and vomiting after day case gynaecological laparoscopy. Anaesthesia 1995; 50: 403-6.
  1. Alon E, Himmelseher S. Ondansetron in the treatment of postoperative vomiting: a randomized, double-blind comparison with droperidol and metoclopramide. Anesth Analg 1992; 75: 561-5.
  1. Desilva P, Darvish A, McDonald S, et al. The efficacy of prophylactic ondansetron, droperidol, perphenazine, and metoclopramide in the prevention of nausea and vomiting after major gynecologic surgery. Anesth Analg 1995; 81: 139-43.
  1. Grond S, Lynch J, Diefenbach C, et al. Comparison of ondansetron and droperidol in the prevention of nausea and vomiting after inpatient minor gynecologic surgery. Anesth Analg 1995; 81: 603-7.
  1. Poler S, White P, Margrabe D, et al. Nausea and vomiting in outpatients—use of droperidol prophylaxis [abstract]. Anesthesiology 1989; 71: A134.
  1. Tang J, Watcha M, White P. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 1996; 83: 304-13.
  1. Sniadach M, Alberts M. A comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy. Anesth Analg 1997; 85: 797-800.
  1. Pandit S, Kothary S, Pandit U. Dose-response study of droperidol and metoclopramide as antiemetics for outpatient anesthesia. Anesth Analg 1989; 68: 798-802.
  1. Abramowitz M, Oh T, Epstein B, et al. The antiemetic effect of droperidol following outpatient strabismus surgery in children. Anesthesiology 1983; 59: 579-83.
  1. Brown R, James D, Weaver G, et al. Low-dose droperidol vs standard-dose droperidol for prevention of vomiting after pediatric strabismus surgery [abstract]. Anesth Analg 1990; 70: S37.
  1. Lin D, Furst S, Rodarte A, et al. A double-blinded comparison of metoclopramide and droperidol for prevention of emesis following strabismus surgery. Anesthesiology 1992; 76: 357-61.
  1. Splinter W, Rhine E, Roberts D, et al. Ondansetron is a better antiemetic than droperidol for tonsillectomy in children. Can J Anaesth 1995; 42: 848-51.
  1. Rosen C, Ratliff A, Wolfe R, et al. The efficacy of intravenous droperidol in the prehospital setting. J Emerg Med 1997; 15: 13-7.
  1. Resnick M, Burton B. Droperidol vs. haloperidol in the initial management of acutely agitated patients. J Clin Psychiatry 1984; 45: 298-9.
  1. Collum C, Merritt F, Orlikowski C. Droperidol and patient-controlled analgesia [letter]. Anaesthesia 1994; 72: 544-7.
  1. Gan T, Collis R, Hetreed M. Double-blind comparison of ondansetron, droperidol and saline in the prevention of postoperative nausea and vomiting. Br J Anaesth 1994; 72: 544-7.
  1. Thomas H, Schwartz E, Petrilli R. Droperidol versus haloperidol for chemical restraint of agitated and combative patients. Ann Emerg Med 92; 21: 407-13.
  1. Lunn D, Lauder G, Williams A, et al. Low-dose droperidol reduces postoperative vomiting in paediatric day surgery. Br J Anaesth 1995; 74: 509-11.
  1. van Leeuwen A, Molders J, Sterkmans P, et al. Droperidol in acutely agitated patients. A double blind placebo-controlled study. J Nerv Ment Dis 1977; 164: 280-3.
  1. Granacher R, Ruth D. Droperidol in acute agitation. Curr Ther Res 1979; 25: 361-5.
  1. Neff K, Denney D, Blachly P. Control of severe agitation with droperidol. Dis Nerv Syst 1972; 33: 594-7.
  1. Barthel J, Marshall J, King P, et al. The effect of droperidol on objective markers of patient cooperation and vital signs during esophagogastroduodenoscopy: a randomized, double-blind, placebo-controlled, prospective investigation. Gastrointest Endosc 1995; 42: 45-50.
  1. Aapro M, Froidevaux P, Roth A, et al. Antiemetic efficacy of droperidol or metoclopramide combined with dexamethasone and diphenhydramine. Oncology 1991; 48: 116-20.
  1. Prescott R, Espley A, Davie I. Double-blind clinical trial of anaesthetic premedication for use in major day surgery. Lancet 1976; 1(7970): 1148-50.
  1. Valanne J, Korttila K. Effect of a small dose of droperidol on nausea, vomiting and recovery after outpatient enflurane anaesthesia. Acta Anaesthesiol Scand 1985; 29: 359-62.
  1. Antrobus J, Abbott P, Carr C, et al. Midazolam–droperidol premedication for cardiac surgery. A comparison with papaveretum and hyoscine. Anaesthesia 1991; 46: 407-9.
  1. Arrowsmith J, Gams R. Dystonia with droperidol therapy. N Engl J Med 1981; 305: 227.
  1. Athanassiadis C, Karamanis A. Akathisia after long-term epidural use of droperidol: a case report. Pain 1992; 50: 203-4.
  1. Pueyo F, Carrascosa F, Lopez L, et al. Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting. Anesth Analg 1996; 83: 117-22.
  1. Jorgensen N, Coyle J. Intravenous droperidol decreases nausea and vomiting after alfentanil anesthesia without increasing recovery time. J Clin Anesth 1990; 2: 312-6.
  1. Ball D. Low-dose droperidol is not devoid of serious side effects [letter]. Anesth Analg 1995; 81: 424-35.
  1. Purhonen S, Kauko M, Koski E, et al. Comparison of tropisetron, droperidol, and saline in the prevention of postoperative nausea and vomiting after gynecologic surgery. Anesth Analg 1997; 84: 662-7.
  1. Cersosimo R, Bromer R, Hoffer S, et al. The antiemetic activity of droperidol administered by intramuscular injection during cisplatin chemotherapy: a pilot study. Drug Intell Clin Pharm 1985; 19: 118-21.
  1. Christensen S, Farrow-Gillespie A, Lerman J. Incidence of emesis and postanesthetic recovery after strabismus surgery in children: a comparison of droperidol and lidocaine. Anesthesiology 1989; 70: 251-4.
  1. Clark R. Tongue-swelling with droperidol. Anaesth Intensive Care 1993; 21: 898.
  1. Kallar S. New modalities in postoperative nausea and vomiting. J Clin Anesth 1992; 4(Suppl 1): 16S-19S.
  1. Corke P, Murray G. Angioedema with droperidol. Anaesth Intensive Care 1993; 21: 375.
  1. Cressman W, Plostnieks J, Johnson P. Absorption, metabolism and excretion of droperidol by human subjects following intramuscular and intravenous administration. Anesthesiology 1973; 38: 363-9.
  1. Davis P, McGowan F, Landsman I, et al. Effect of antiemetic therapy on recovery and hospital discharge time: a double-blind assessment of ondansetron, droperidol, and placebo in pediatric patients undergoing ambulatory surgery. Anesthesiology 1995; 83: 956-60.
  1. Grunberg S, Heskith P. Control of chemotherapy-induced emesis. N Engl J Med 1993; 1790-6.
  1. Ellison J. Emergency treatment of acute psychosis, agitation, and anxiety. Hosp Community Psychiatry 1985; 36: 351-2.
  1. Wilcox C, Forsmark C, Cello J. Utility of droperidol for conscious sedation in gastrointestinal endoscopic procedures. Gastrointest Endosc 1990; 36: 112-5.
  1. Lischke V, Behne M, Doelken P, et al. Droperidol causes a dose-dependent prolongation of the QT interval. Anesth Analg 1994; 79: 983-6.


  1. Hooper J. Droperidol and acute psychosis [letter]. J Clin Psychopharmacol 1987; 7: 198.
  1. Frye M, Condreaut M, Hakeman S, et al. Continuous droperidol infusion for management of agitated delirium in an intensive care unit. Psychosomatics 1995; 36: 301-5.
  1. Reves J, Glass P, Lubarsky D. Nonbarbiturate intravenous anesthetics. In: Miller R, editor. Anesthesia. 4th ed. New York: Churchill Livingstone; 1994. p. 247-89.
  1. Grunwald Z, Torjman M, Schieren H, et al. The pharmacokinetics of droperidol in anesthetized children. Anesth Analg 1993; 76: 1238-42.
  1. Grunwald Z, Scheiner M, Parness J, et al. Droperidol decreases vomiting after tonsillectomy and adenoidectomy in children [abstract]. Anesth Analg 1990; 70: S138.
  1. Hyatt M, Muldoon S, Rorie D. Droperidol, a selective antagonist of postsynaptic -adrenoceptors in the canine saphenous vein. Anesthesiology 1980; 53: 281-6.
  1. Lerman J, Eustis S, Smith D. Effect of droperidol pretreatment on postanesthetic vomiting in children undergoing strabismus surgery. Anesthesiology 1986; 65: 322-5.
  1. Lawrence K, Nasraway S. Conduction disturbances associated with administration of butyrophenone antipsychotics in the critically ill: a review of the literature. Pharmacotherapy 1997; 17: 531-7.
  1. Lehmann K, Van Peer A, Ikonomakis M, et al. Pharmacokinetics of droperidol in surgical patients under different conditions of anaesthesia. Br J Anaesth 1988; 61: 297-301.
  1. Fischler M, Bonnet F, Trang H, et al. The pharmacokinetics of droperidol in anesthetized patients. Anesthesiology 1986; 64: 486-9.
  1. Nageotte M, Briggs G, Towers C, et al. Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol 1996; 174: 1801-6.
  1. Palombaro J, Klingelberger C. Angioedema associated with droperidol administration. Ann Emerg Med 1996; 27: 379-81.
  1. Foster P, Stickle B, Laurence A, et al. Akathesia following low-dose droperidol for antiemesis in day-case patients. Anaesthesia 1996; 51: 491-4.
  1. Melnick B. Extrapyramidal reactions to low-dose droperidol. Anesthesiology 1988; 69: 424-6.
  1. Melnick B, Sawyer R, Karambelkar D, et al. Delayed side effects of droperidol after ambulatory general anesthesia. Anesth Analg 1989; 69: 748-51.
  1. Ward N. Akathisia associated with droperidol during epidural anesthesia. Anesthesiology 1989; 71: 786-7.
  1. Wagner B, Berman S, Devitt P, et al. Retrospective analysis of postoperative nausea and vomiting to determine antiemetic activity of droperidol added to propofol: a possible drug interaction. Pharmacotherapy 1994; 14: 586-91.
  1. Ray J, Newton D, Nye M, et al. Droperidol stability in intravenous admixtures. Am J Hosp Pharm 1983; 40: 94-7.
  1. Langer G, Pühringer W. Haloperidol and droperidol treatment in schizophrenics. Clinical application of the “prolactin-model”. Acta Psychiatr Belg 1980; 80: 574-83.
  1. Ratan D, Smith A. Neuroleptic malignant syndrome secondary to droperidol. Biol Psychiatry 1993; 34: 421-2.
  1. Sumikawa K, Amakata Y. The pressor effect of droperidol on a patient with pheochromocytoma. Anesthesiology 1977; 46: 359-61.
  1. Schreibman D. Treatment of a delayed reaction to droperidol with diphenhydramine [letter]. Anesth Analg 1990; 71: 105.
  1. Shaw A. Postoperative neuroleptic malignant syndrome. Anaesthesia 1995; 50: 246-7.
  1. Panel consensus, review of monograph 2/98.
  1. Panel comment, 2/98.
  1. Panel comment, 2/98
  1. Panel comment, 2/98
  1. Ahmed, Shahid, Vice President, QA/QC and Regulatory Affairs, Important drug warning (from Dear Health Care Professional letter). Akorn Pharmaceutical, Inc., Emeryville, CA. 12/04/01
  1. Expert Committee comment, 1/2002.
  1. Expert Committee comment, 1/2002.
  1. Reviewers' responses to Anesthesiology and Gastroenterology Disease Expert Committee Ballot of 1/23/02.
  1. Expert Committee comment, 1/2002.
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