Droperidol

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

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

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.

  Route/Dosage

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

  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.

Barbiturates are physically incompatible with droperidol.

  Lab Test Interferences 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. OTHER: Muscular rigidity; chills or shivering.

  Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy in children less than 2 yr not established. Special Risk Patients: Decreased dose may be necessary. Use drug with caution in elderly, debilitated and hepatically or renally impaired patients. Cardiac Conduction: Cases of QT prolongation and serious arrhythmias (eg, torsades de pointes, ventricular arrhythmias, cardiac arrest, death) may occur. Some cases have occurred in patients with no known risk factors for QT prolongation. Administer with caution to patients at risk for development of prolonged QT syndrome (eg, CHF, bradycardia, use of a diuretic, cardiac hypertrophy, other drugs known to prolong the QT interval, cardiac disease, electrolyte imbalance). Neuroleptic Malignant Syndrome: Rare cases of neuroleptic malignant syndrome (eg, altered consciousness, muscle rigidity, autonomic instability) have been reported.

  Administration/Storage

• If direct IV has been ordered, administer at slow rate (do not exceed 10 mg/30 to 60 sec).
• Administer with caution to patients at risk for development of prolonged QT syndrome (eg, CHF, bradycardia, use of a diuretic, cardiac hypertrophy, other drugs known to prolong the QT interval, cardiac disease, electrolyte imbalance).
• Store at room temperature and protect from light. Solution remains stable for 7 to 10 days.
• Compatible when mixed in syringe with atropine, butorphanol, chlorpromazine, fentanyl, glycopyrrolate, hydroxyzine, morphine, meperidine, perphenazine, promazine, promethazine, or scopolamine.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain a 12-lead ECG prior to administration of droperidol to determine if a prolonged QT interval (ie, QTc greater than 440 msec for men or greater than 450 msec for women) is present. If prolonged QT interval is present, do not administer droperidol.
• Monitor ECG prior to treatment and continue for 2 to 3 hr 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.
• If patient experiences drowsiness, keep siderails up and assist with ambulation.
• If extrapyramidal symptoms (eg, dystonia, hyperactivity, neck extension) occur, notify health care provider immediately.

  Patient/Family Education

• 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 hr after treatment.