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The Annals of Pharmacotherapy Feb 2015To evaluate the safety and efficacy of droperidol for the relief of acute migraine headaches. (Review)
Review
OBJECTIVE
To evaluate the safety and efficacy of droperidol for the relief of acute migraine headaches.
DATA SOURCES
A MEDLINE search (1946 to August 2014) was performed using the following keywords and associated medical subject headings: droperidol, inapsine, headache, migraine, and migraine disorder.
STUDY SELECTION AND DATA EXTRACTION
The search was conducted to identify randomized controlled trials comparing droperidol with placebo or an active control in adult patients with acute migraine headaches that were published in English. Primary end points included acute headache improvement after the intervention. Safety end points included the frequency of extrapyramidal symptoms, somnolence, and cardiac adverse effects.
DATA SYNTHESIS
In all, 5 manuscripts are included in this review. Patients presenting to the emergency department with acute headache desire rapid pain relief, which was the primary objective in each of the evaluated studies. Droperidol was better than placebo and at least as effective as comparator drugs such as prochlorperazine, meperidine, or olanzapine using droperidol doses of 2.5 to 5 mg, given either intramuscularly (IM) or intravenously (IV). The most commonly reported adverse effects were extrapyramidal symptoms and sedation. Cardiac adverse effects were not reported in any of the studies; however, only 2 articles described using cardiac monitoring.
CONCLUSIONS
Parenteral droperidol is an effective option for the treatment of acute migraine. The minimum effective dose is 2.5 mg given IM or IV. Clinicians must be aware of the risk for adverse events, select appropriate patients, perform EKG monitoring for patients at risk of QTc prolongation, and institute treatment if necessary.
Topics: Acute Disease; Dopamine Antagonists; Droperidol; Humans; Migraine Disorders; Randomized Controlled Trials as Topic
PubMed: 25416184
DOI: 10.1177/1060028014554445 -
The Journal of Emergency Medicine Oct 2011Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia, and sickle cell disease represent a significant portion of emergency department... (Review)
Review
BACKGROUND
Patients with acute and chronic pain syndromes such as migraine headache, fibromyalgia, and sickle cell disease represent a significant portion of emergency department (ED) visits. Certain patients may have tolerance to opioid analgesics and often require large doses and prolonged time in the ED to achieve satisfactory pain mitigation. Droperidol is a unique drug that has been successfully used not only as an analgesic adjuvant for the past 30 years, but also for treatment of nausea/vomiting, psychosis, agitation, sedation, and vertigo.
OBJECTIVES
In this review, we examine the evidence supporting the use of droperidol for analgesia, adverse side effects, and controversial United States (US) Food and Drug Administration (FDA) black box warning.
DISCUSSION
Droperidol has myriad pharmacologic properties that may explain its efficacy as an analgesic, including: dopamine D2 antagonist, dose-dependent GABA agonist/antagonist, α2 adrenoreceptor agonist, serotonin antagonist, histamine antagonist, muscarinic and nicotinic cholinergic antagonist, anticholinesterase activity, sodium channel blockade similar to lidocaine, and μ opiate receptor potentiation.
CONCLUSION
Droperidol is an important adjuvant for patients who are tolerant to opioid analgesics. The FDA black box warning does not apply to doses below 2.5 mg.
Topics: Adjuvants, Anesthesia; Analgesics, Opioid; Droperidol; Drug Tolerance; Humans; Pain
PubMed: 20832967
DOI: 10.1016/j.jemermed.2010.07.005 -
The Journal of Emergency Medicine May 2003Droperidol is an antipsychotic and antiemetic drug that has been used extensively by emergency physicians, psychiatrists, and anesthesiologists worldwide since 1967. It... (Review)
Review
Droperidol is an antipsychotic and antiemetic drug that has been used extensively by emergency physicians, psychiatrists, and anesthesiologists worldwide since 1967. It also has been used effectively for other diverse conditions, such as treatment of headache and vertigo. As of January 2001, Droperidol was no longer available in Europe after its founder, Janssen-Cilag Pharmaceuticals, discontinued its distribution. In December 2001, the United States Food and Drug Administration (FDA) placed a black box warning on the use of Droperidol in response to an association between Droperidol and fatal cardiac dysrhythmias, such as torsade de pointes, resulting from prolongation of the QT interval. In this review we closely examine the pharmacology, indications, use, and complications associated with Droperidol, and speculate on its future use in the Emergency Department.
Topics: Antiemetics; Antipsychotic Agents; Death, Sudden, Cardiac; Droperidol; Drug Labeling; Emergency Treatment; Humans; Long QT Syndrome; Patient Selection; Risk Factors; Safety; Torsades de Pointes; United States; United States Food and Drug Administration
PubMed: 12745049
DOI: 10.1016/s0736-4679(03)00044-1 -
Journal of Anesthesia Dec 2023Perioperative shivering is common and can occur as a result of hypothermia or changes in the threshold of thermoregulation. Droperidol usage for anesthesia is currently...
PURPOSE
Perioperative shivering is common and can occur as a result of hypothermia or changes in the threshold of thermoregulation. Droperidol usage for anesthesia is currently limited to its sedative and antiemetic effects. We investigated the effects of high and low doses of droperidol on the shivering threshold in rabbits.
METHODS
Forty-two male Japanese white rabbits were anesthetized with isoflurane and randomly assigned to the control, high-dose, or low-dose group. Rabbits in the high-dose group received a 5 mg/kg droperidol bolus followed by continuous infusion at 5 mg/kg/h, those in the low-dose group received a 0.5 mg/kg droperidol bolus, and those in the control group received the same volume of saline as the high-dose group. Body temperature was reduced at a rate of 2-3 °C/h, and the shivering threshold was defined as the subject's core temperature (°C) at the onset of shivering.
RESULTS
The shivering thresholds in the control, high-dose, and low-dose groups were 38.1 °C ± 1.1 °C, 36.7 °C ± 1.2 °C, and 36.9 °C ± 1.0 °C, respectively. The shivering thresholds were significantly lower in the high-dose and low-dose groups than in the control group (P < 0.01). The thresholds were comparable between the high-dose and low-dose groups.
CONCLUSIONS
Droperidol in high and low doses effectively reduced the shivering threshold in rabbits. Droperidol has been used in low doses as an antiemetic. Low doses of droperidol can reduce the incidence of shivering perioperatively and during the induction of therapeutic hypothermia.
Topics: Animals; Rabbits; Male; Shivering; Droperidol; Body Temperature; Isoflurane; Hypothermia
PubMed: 37566231
DOI: 10.1007/s00540-023-03240-1 -
The Cochrane Database of Systematic... Nov 2014This is an updated version of the original Cochrane review published in Issue 10, 2010, on droperidol for the treatment of nausea and vomiting in palliative care... (Review)
Review
BACKGROUND
This is an updated version of the original Cochrane review published in Issue 10, 2010, on droperidol for the treatment of nausea and vomiting in palliative care patients. Nausea and vomiting are common symptoms in patients with terminal illness and can be very unpleasant and distressing. There are several different types of antiemetic treatments that can be used to control these symptoms. Droperidol is an antipsychotic drug and has been used and studied as an antiemetic in the management of postoperative and chemotherapy nausea and vomiting.
OBJECTIVES
To evaluate the efficacy and adverse events (both minor and serious) associated with the use of droperidol for the treatment of nausea and vomiting in palliative care patients.
SEARCH METHODS
We searched electronic databases including CENTRAL, MEDLINE (1950-), EMBASE (1980-), CINAHL (1981-) and AMED (1985-), using relevant search terms and synonyms. The basic search strategy was ("droperidol" OR "butyrophenone") AND ("nausea" OR "vomiting"), modified for each database. We updated the search on 2 December 2009. We performed updated searches of MEDLINE, EMBASE, CENTRAL and AMED 2009 to 2013 on 19 November 2013 and of CINAHL on 20 November 2013. We also searched trial registers (metaRegister of controlled trials (www.controlled-trials.com/mrct), clinicaltrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/)) on 22 November 2013, using the keyword "droperidol".
SELECTION CRITERIA
Randomised controlled trials (RCTs) of droperidol for the treatment of nausea or vomiting, or both, in adults receiving palliative care or suffering from an incurable progressive medical condition.
DATA COLLECTION AND ANALYSIS
We judged the potential relevance of studies based on their titles and abstracts, and obtained studies that we anticipated might meet the inclusion criteria. Two review authors independently reviewed the abstracts for the initial review and four review authors reviewed the abstracts for the update to assess suitability for inclusion. We discussed discrepancies to achieve consensus.
MAIN RESULTS
The 2010 search strategy identified 1664 abstracts (and 827 duplicates) of which we obtained 23 studies in full as potentially meeting the inclusion criteria. On review of the full papers, we identified no studies that met the inclusion criteria.The updated searches carried out in November 2013 identified 304 abstracts (261 excluding duplicates) of which we obtained 18 references in full as potentially meeting the inclusion criteria. On review of the full papers, we identified no studies that met the inclusion criteria, therefore there were no included studies in this review.We found no registered trials of droperidol for the management of nausea or vomiting in palliative care.
AUTHORS' CONCLUSIONS
Since first publication of this review, no new studies were found. There is insufficient evidence to advise on the use of droperidol for the management of nausea and vomiting in palliative care. Studies of antiemetics in palliative care settings are needed to identify which agents are most effective, with minimum side effects.
Topics: Adult; Antiemetics; Droperidol; Humans; Nausea; Palliative Care; Terminal Care; Vomiting
PubMed: 25429434
DOI: 10.1002/14651858.CD006938.pub3 -
The Journal of Clinical Psychiatry Oct 1999As admission criteria to inpatient units become more focused on patient safety and behavioral instability, primary treatment often requires use of medications that need... (Comparative Study)
Comparative Study Review
BACKGROUND
As admission criteria to inpatient units become more focused on patient safety and behavioral instability, primary treatment often requires use of medications that need to be quick, safe, and effective for control of agitation. This article reviews the evidence that droperidol may serve as the optimal medication for this task.
DATA SOURCES
A comprehensive MEDLINE search of English-language literature was conducted using the search term droperidol concerning the use of droperidol in psychiatric emergencies. Cross-referencing of those articles was conducted to include pertinent articles in the non-psychiatric and European literature regarding safety and early development of the drug.
STUDY FINDINGS
As evidenced in the animal and clinical literature, studies demonstrate the efficacy and rapidity of onset of droperidol and its relative safety compared with the most widely used antiagitation drug, haloperidol. Evidence for this use of droperidol is particularly compelling for situations in which intramuscular administration is necessary.
CONCLUSION
Droperidol, while not in widespread use, may prove to be the superior typical neuroleptic for psychiatric emergencies. Increased clinical utilization and study of droperidol for this use is warranted.
Topics: Acute Disease; Animals; Antipsychotic Agents; Clinical Trials as Topic; Crisis Intervention; Dangerous Behavior; Droperidol; Emergency Services, Psychiatric; Haloperidol; Humans; Injections, Intramuscular; Mental Disorders; Psychomotor Agitation; Rats
PubMed: 10549682
DOI: No ID Found -
Gastroenterology Nursing : the Official... Oct 1992Droperidol may be used to bring about conscious sedation in therapeutic and diagnostic endoscopy. Droperidol is a neuroleptic tranquilizer that produces marked...
Droperidol may be used to bring about conscious sedation in therapeutic and diagnostic endoscopy. Droperidol is a neuroleptic tranquilizer that produces marked tranquilization and sedation. Droperidol may be used to allay apprehension and provide a state of mental detachment while maintaining reflex alterness necessary in endoscopic interventions. Adverse reactions to droperidol are generally self-limiting or readily managed with hydration to correct hypotension.
Topics: Adjuvants, Anesthesia; Conscious Sedation; Droperidol; Humans
PubMed: 1420398
DOI: No ID Found -
Tijdschrift Voor Psychiatrie 2013In Flemish emergency psychiatry droperidol is still an option for the treatment of agitation. However, its efficacy and safety are contested. (Review)
Review
BACKGROUND
In Flemish emergency psychiatry droperidol is still an option for the treatment of agitation. However, its efficacy and safety are contested.
AIM
To find out whether the continuing use of droperidol to treat agitation is justified on scientific grounds.
METHOD
Randomised controlled trials of droperidol (intramuscular or intravenous) were traced via a systematic search of the literature. These data were supplemented with a description of the drug’s most important pharmacological properties and a survey of the literature on cardiac side-effects and of the place accorded to droperidol in some guidelines.
RESULTS
The efficacy and safety of droperidol (IM/IV) were studied in 8 randomised control-led trials: 352 patients treated with droperidol. Droperidol was compared with benzodiazepines, antipsychotics and combination treatment. A single injection of droperidol was successful in 64-92% of patients. Droperidol tended to act faster and be more effective than haloperidol and lorazepam. There were very few side-effects. No clinically important cardiac side-effects were reported; this is also in keeping with evidence revealed in systematic reviews on the subject. The ecological validity of the trials was high.
CONCLUSION
In spite of a decline in the popularity of droperidol in most guidelines, the drug still seems to play a valuable role in the treatment of the agitated patient. Because it acts rapidly over a short period of time and is safe to use in patients with high (co)morbidity, it is still in favour with many health professionals.
Topics: Acute Disease; Antipsychotic Agents; Droperidol; Humans; Psychotic Disorders; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23512631
DOI: No ID Found -
The Cochrane Database of Systematic... Oct 2004People suffering from acute psychotic illnesses, especially those associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or... (Review)
Review
BACKGROUND
People suffering from acute psychotic illnesses, especially those associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation. Droperidol, a butyrophenone neuroleptic, has been used for this purpose in several countries.
OBJECTIVES
To estimate the effects of droperidol compared to other treatments for controlling disturbed behaviour and reducing psychotic symptoms for people with suspected acute psychotic illnesses.
SEARCH STRATEGY
We updated previous searches by searching the Cochrane Schizophrenia Group Register (September 2003). References of all identified studies were searched for further trial citations and authors of trials were contacted. Twenty-one other databases were also searched as part of a broader project and this composite database was searched for this review. This was supplemented by hand searching reference lists and contacting both the pharmacological industry and relevant authors.
SELECTION CRITERIA
The review included randomised controlled trials comparing droperidol to any other treatment for people with suspected acute psychotic illnesses, including schizophrenia, schizoaffective disorder, mixed affective disorders, the manic phase of bipolar disorder or a brief psychotic episode.
DATA COLLECTION AND ANALYSIS
Relevant studies were selected for inclusion, their quality was assessed and data extracted. Data were excluded when more than 50% of participants were lost to follow up. For binary outcomes, standard estimates of risk ratio (RR) and the corresponding 95% confidence intervals (CI) were calculated. Where possible, weighted number needed to treat or harm statistics (NNT, NNH), and the corresponding 95% confidence intervals (CI), were calculated.
MAIN RESULTS
We identified only two relevant trials. One additional study focused on outcomes at 30 days rather than at a few hours. One small (n = 41) randomised trial compared intravenous (iv) droperidol (10 mg) with iv placebo and found that people allocated to droperidol were significantly less likely to need additional injections of another drug, haloperidol, in the first few minutes (n = 41, RR 0.37 CI 0.2 to 0.7, NNT 2 CI 1 to 10) compared to those given placebo. By 90 minutes this difference was still evident but not statistically significant (RR 0.46 CI 0.2 to 1.2). When 5 mg intramuscular (im) droperidol was compared with 5 mg im haloperidol, those given droperidol were also less likely to need additional injections by 30 minutes, than those given haloperidol, but this result was not statistically significant (n = 27, RR 0.45 CI 0.2 to 1.01). One person out of the 16 given haloperidol experienced a mild dystonic reaction (muscle spasms or abnormal contractions), while none of the 11 people allocated to droperidol were reported to have experienced adverse effects.
REVIEWERS' CONCLUSIONS
This is an important, and surprisingly under-researched, area. To date, use of droperidol for emergency situations has been justified by experience rather than evidence from well conducted and reported randomised trials, but, as world reserves diminish, droperidol will no longer be a treatment option.
Topics: Acute Disease; Antipsychotic Agents; Droperidol; Humans; Psychotic Disorders; Randomized Controlled Trials as Topic
PubMed: 15495037
DOI: 10.1002/14651858.CD002830.pub2 -
The Cochrane Database of Systematic... 2001People with acute psychotic illnesses, especially when associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation.... (Review)
Review
BACKGROUND
People with acute psychotic illnesses, especially when associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation. Droperidol, a butyrophenone neuroleptic, is used for this purpose in several countries.
OBJECTIVES
To estimate the effects of droperidol when compared to other treatments for controlling disturbed behaviour and reducing psychotic symptoms for people with suspected acute psychotic illnesses.
SEARCH STRATEGY
The Cochrane Controlled Trials Register (Issue 2, 2000), The Cochrane Schizophrenia Group's Register (May 2000), EMBASE (1980-2000), MEDLINE (1966-2000), PASCAL (1973-2000) and PsycLIT (1970-2000) were methodically searched. Twenty-one other databases were also searched as part of a broader project and this composite database was searched for this review. This was supplemented by hand searching reference lists, contacting industry and relevant authors.
SELECTION CRITERIA
Randomised clinical trials comparing droperidol to any treatment, for people with suspected acute psychotic illnesses, such as schizophrenia, schizoaffective disorder, mixed affective disorders, manic phase of bipolar disorder or brief psychotic episode.
DATA COLLECTION AND ANALYSIS
Studies were reliably selected, quality assessed and data extracted. Data were excluded where more than 50% of participants were lost to follow up. For binary outcomes, standard estimations of risk ratio (RR) and their 95% confidence intervals (CI) were calculated. Where possible, weighted number needed to treat or harm statistics (NNT, NNH), and their 95% confidence intervals (CI), were also calculated.
MAIN RESULTS
Only two clearly relevant randomised trials with usable data were identified. One additional study was included but focused on outcomes at 30 days rather than a few hours. One small (n=41) randomised trial compared droperidol (10mg IV) with placebo IV and found that people allocated to droperidol were significantly less likely to need additional haloperidol injections in the first few minutes (n=41, RR 0.37 CI 0.2 to 0.7, NNT 2 CI 1 to 10) than those given placebo. By 90 minutes this difference was still evident but not statistically significant (RR 0.46 CI 0.2 to 1.2). When 5mg IM droperidol was compared to 5mg IM haloperidol people given droperidol were again less likely to need additional injections by 30 minutes, than those given haloperidol, but this result did not quite reach conventional levels of statistical significance (n=27, RR 0.45 CI 0.2 to 1.01). One person out of 16 given haloperidol experienced a mild dystonic reaction, and none of the 11 people allocated to droperidol were reported to have experienced adverse effects.
REVIEWER'S CONCLUSIONS
This is an important and surprisingly under-researched area. Use of droperidol for the emergency situation is currently justified on experience rather than evidence from well conducted and reported randomised trials.
Topics: Acute Disease; Antipsychotic Agents; Droperidol; Humans; Psychotic Disorders; Randomized Controlled Trials as Topic
PubMed: 11406047
DOI: 10.1002/14651858.CD002830