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Droperidol

Pronunciation

Pronunciation: dro-PER-i-dahl
Class: General anesthetic

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Trade Names

Droperidol
- Injection 2.5 mg/mL

Pharmacology

Produces tranquilization, sedation and antiemetic effects, as well as mild alpha-adrenergic blockade, resulting in hypotension and decreased peripheral vascular resistance.

Pharmacokinetics

Distribution

Vd is 1.5 L/kg (at steady-state). Biphasic distribution with a t _½ of approximately 1.4 min (rapid phase) and approximately 14.3 min (slower phase).

Metabolism

Extensively metabolized.

Elimination

IM

Approximately 75% excreted in the urine (1% as unchanged drug) and 22% excreted in feces. t _½ approximately 134 min.

Onset

3 to 10 min.

Peak

30 min.

Duration

2 to 4 h.

Indications and Usage

Reduction of incidence of nausea and vomiting in surgical and diagnostic procedures.

Unlabeled Uses

Antiemetic in cancer chemotherapy.

Contraindications

Known or suspected QT prolongation (ie, QTc interval greater than 440 msec for men or greater than 450 msec for women), including patients with congenital long QT syndrome. Hypersensitivity to butyrophenones.

Dosage and Administration

Adults

IM or slow IV 2.5 mg max recommended initial dose; additional 1.25 mg doses may be administered to achieve desired effect.

Children (2 to 12 yr of age)

IM / IV 0.1 mg/kg max recommended initial dose, taking into account age and other clinical factors.

Y-Site

Compatible when mixed in syringe with atropine, butorphanol, chlorpromazine, fentanyl, glycopyrrolate, hydroxyzine, morphine, meperidine, perphenazine, promazine, promethazine, or scopolamine.

Storage/Stability

Store at room temperature and protect from light. Solution remains stable for 7 to 10 days.

Drug Interactions

CNS depressants

Additive CNS depression may result.

Diuretics, drugs known to increase the QT interval (eg, cisapride, pimozide)

Risk of life-threatening arrhythmias, including torsades de pointes, may be increased.

Incompatibility

Barbiturates are physically incompatible with droperidol.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

QT interval prolongation; torsades de pointes; cardiac arrest; ventricular tachycardia; hypotension.

CNS

Postoperative drowsiness; extrapyramidal effects (eg, dystonia, akathisia and oculogyric crisis); restlessness; hyperactivity; anxiety; dizziness; postoperative hallucinations; mental depression.

Respiratory

Respiratory depression; bronchospasm; laryngospasm.

Miscellaneous

Muscular rigidity; chills or shivering.

Precautions

Warnings

Contraindications

Contraindicated in patients with known or suspected QT prolongation.

QT prolongation/torsades de pointes

Have been reported at or below recommended doses. Some cases have been in patients without known risk factors for QT prolongation. Some cases have been fatal. Perform baseline 12-lead ECG prior to initiation of therapy. Do not administer if QTc is greater than 440 msec in men or 450 msec in women. Use with extreme caution in patients at risk of developing prolonged QT syndrome (eg, CHF, bradycardia, diuretic use, cardiac hypertrophy, hypokalemia, hypomagnesemia, drugs that prolong QT interval, older than 65 yr of age, alcohol abuse, or taking benzodiazepines, volatile anesthetics, or IV opiates).

Refractory disease

Reserve treatment in refractory disease because of serious proarrhythmic effects.

Monitor

Monitor ECG prior to treatment and continue for 2 to 3 h after completing treatment to monitor for arrhythmias if the potential benefit outweighs the risk of potentially serious arrhythmias. Assess patient's respiratory status continuously. If patient is receiving narcotic analgesic concurrently, respiratory depression may occur. Note extrapyramidal symptoms.

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 2 yr of age not established.

Special Risk Patients

Decreased dose may be necessary. Use drug with caution in elderly, debilitated, and hepatically or renally impaired patients.

Neuroleptic malignant syndrome

Rare cases of neuroleptic malignant syndrome (eg, altered consciousness, muscle rigidity, autonomic instability) have been reported.

Overdosage

Symptoms

Extension of pharmacologic effects, including QT prolongation, serious arrhythmias (eg, torsades de pointes), sedation, and hypotension.

Patient Information

Caution patient to avoid sudden changes in position to prevent orthostatic hypotension.
Instruct patient to call for help before rising from bed.
Advise patient to avoid intake of alcoholic beverages or other CNS depressants for greater than or equal to 24 h after treatment.

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