droperidol (Droleptan)

see also:

• anti-psychotic medications

• droperidol is a butyrophenone type antipsychotic agent which is similar to haloperidol
• it produces marked tranquillization and sedation as well as having an anti-emetic effect
• it potentiates other CNS depressants
• also produces mild alpha-adrenergic blockade, peripheral vascular dilatation, hypotension, and reduction of the pressor effect of adrenaline
• as with all drugs, benefits of using droperidol should be weighed against the potential risk

• known HS
• severe CNS depression
• Parkinson's disease
• phaeochromocytoma - severe hypertension and tachycardia may occur
• lactation
• prolonged QTc > 450msec (eg. congenital causes, or patients at risk of this such as other medications which cause it, hypokalaemia, hypomagnesaemia, hypocalcaemia, bradycardia, etc)
• relative C/I: acute alcohol intoxication

• FH sudden death
• PH cardiac disease
• acute kidney injury (AKI) / acute renal failure (ARF) or chronic renal failure
• liver impairment
• chronic obstructive pulmonary disease (COPD) or significant respiratory disease
• patients at risk of electrolyte disturbances such as those on diuretics
• ensure cardiac monitoring and resuscitation facilities are nearby in case the low risk of torsade de pointes VT eventuates, or the patient has a respiratory arrest (more likely to occur withconcurrent sedatives such as opiates and opioids, particularly if these are given rapidly iv)
• reduce initial doses of concurrent opiates and opioids to 1/3rd of normal doses
• pregnancy in 3rd trimester as risk of neonatal extrapyramidal effects
• lactation
• safety not established in children under 2yrs
• no use of machinery or driving within 24hrs of dose if dose > 5mg (10hrs for 5mg doses)
• elderly

• very rapidly absorbed following intramuscular administration, and the distribution phase half-life for plasma is ~10 minutes
• onset of action is 3-10 minutes following intravenous or intramuscular administration, although maximum effect may be delayed until 30 minutes
• terminal plasma half life ~134 minutes
• duration of sedative effect is 2-4 hrs, but altered consciousness may persist for up to 12 hrs

• sedation, dizziness
• hypotension - can Rx with iv fluids +/- metaraminol (Aramine)
• tachycardia
• anticholinergic effects including urinary retention may occur
• respiratory depression especially with concurrent sedatives or opiates and opioids
• extrapyramidal reactions such as oculogyric crisis, dystonic reactions, akathisia - may require Rx with benztropine, etc
• neuroleptic malignant syndrome (NMS)
• torsade de pointes VT if develops prolonged QTc
• seizures may occur in toxic doses
• other adverse effects, most are not clinically important in the ED setting when it is used to Rx severe agitation

• healthy adults excluding the elderly:
  • 10mg im (can be repeated every 4-6hrs prn, and doses up to 25mg im can be used), or,
  • iv infusion 25-50mg in 250ml 0.9% saline over 20 minutes up to twice daily