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Expert Opinion on Drug Safety Jul 2004By the year 2000, droperidol had become a standard drug for the treatment of behavioural emergencies in both psychiatric and medical settings. In 2001, the US FDA issued... (Review)
Review
By the year 2000, droperidol had become a standard drug for the treatment of behavioural emergencies in both psychiatric and medical settings. In 2001, the US FDA issued a 'black box' warning, citing cases of QT prolongation and/or torsades de pointes. As a result, the use of droperidol has been sharply circumscribed. The authors will review the literature on antipsychotic medications in general, focusing on droperidol in particular, with regard to QT interval prolongation, dysrhythmia, and sudden death. In addition, the mechanism of drug-induced QT interval prolongation will be discussed. The authors will then review their extensive experience with droperidol. The authors conclude that, while in theory droperidol may prolong the QT interval to an extent similar to thioridazine, its long history of clinical use has shown no pattern of sudden deaths analogous to those that provoked the FDA warning. Although the numbers presented by the FDA initially appear alarming, after further evaluation it is clear that more definitive studies should have been carried out. Droperidol is safe, extremely effective, and now underused as a treatment for severely agitated or violent patients.
Topics: Adjuvants, Anesthesia; Antipsychotic Agents; Droperidol; Drug Labeling; Emergency Services, Psychiatric; Emergency Treatment; Humans; Long QT Syndrome; Psychomotor Agitation; Torsades de Pointes; United States; United States Food and Drug Administration
PubMed: 15268653
DOI: 10.1517/14740338.3.4.369 -
The Cochrane Database of Systematic... Oct 2010Nausea and vomiting are common symptoms in patients with terminal illness and can be very unpleasant and distressing. There are several different types of antiemetic... (Review)
Review
BACKGROUND
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 which 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 post-operative 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 STRATEGY
We searched electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, using relevant search terms and synonyms. The basic search strategy was ("droperidol" OR "butyrophenone") AND ("nausea" OR "vomiting"), modified for each database. The search was updated on 2 December 2009.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of droperidol for the treatment of nausea or vomiting, or both, for 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 which we anticipated might meet the inclusion criteria. We both read these to assess suitability for inclusion. Discrepancies were discussed to achieve consensus.
MAIN RESULTS
The search strategy identified 1664 abstracts (and 827 duplicates) of which 23 studies were obtained in full as potentially meeting the inclusion criteria. On review of the full papers, no studies were identified which met the inclusion criteria, therefore, there were no included studies in this review.
AUTHORS' CONCLUSIONS
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 a minimum of side effects.
Topics: Adult; Antiemetics; Droperidol; Humans; Nausea; Palliative Care; Terminal Care; Vomiting
PubMed: 20927752
DOI: 10.1002/14651858.CD006938.pub2 -
Drugs 2006Droperidol (Dehydrobenzperidol, Dehidrobenzoperidol, Dridol, Droleptan, Inapsine) is a dopamine D(2) receptor antagonist that has been widely used in adults and children... (Comparative Study)
Comparative Study Review
Droperidol (Dehydrobenzperidol, Dehidrobenzoperidol, Dridol, Droleptan, Inapsine) is a dopamine D(2) receptor antagonist that has been widely used in adults and children for the prevention and treatment of postoperative nausea and vomiting (PONV) over several decades and, more recently, for the prevention of opioid-induced PONV during patient-controlled analgesia (PCA) in adults. In well controlled clinical trials of patients undergoing surgery, the efficacy of single-dose intravenous (IV) droperidol in preventing PONV was similar to that of ondansetron and dexamethasone. Droperidol significantly reduced opioid-induced PONV in adults during PCA and had a morphine-sparing effect. Droperidol is generally well tolerated and the incidence of adverse effects is similar to that observed with placebo and the serotonin 5-HT(3) receptor antagonists (setrons). Guidelines recommend that, in adults, droperidol monotherapy be considered for those at moderate risk of PONV, and droperidol in combination with a setron and/or dexamethasone be considered for patients at moderate or high risk of PONV. In children with moderate or high risk of PONV, droperidol is recommended for first-line use in some countries, and second-line use in others.
Topics: Adolescent; Adult; Analgesia, Patient-Controlled; Antiemetics; Child; Child, Preschool; Clinical Trials as Topic; Droperidol; Humans; Infant; Infusions, Intravenous; Postoperative Nausea and Vomiting; Serotonin 5-HT3 Receptor Antagonists
PubMed: 17112307
DOI: 10.2165/00003495-200666160-00009 -
Anesthesia Progress Sep 2020
Topics: Droperidol; Humans; Postoperative Nausea and Vomiting
PubMed: 32992339
DOI: 10.2344/anpr-67-03-14 -
Anaesthesia Nov 2009
Topics: Anesthesiology; Antiemetics; Droperidol; Drug Administration Schedule; Drug Therapy, Combination; Humans; Long QT Syndrome; Postoperative Nausea and Vomiting
PubMed: 19825047
DOI: 10.1111/j.1365-2044.2009.06124.x -
European Journal of Anaesthesiology Jun 2012Droperidol is widely used for the prevention of postoperative nausea and vomiting (PONV) in European countries. It is unclear how efficacious low-dose droperidol is in... (Meta-Analysis)
Meta-Analysis Review
Low-dose droperidol (≤1 mg or ≤15 μg kg-1) for the prevention of postoperative nausea and vomiting in adults: quantitative systematic review of randomised controlled trials.
CONTEXT
Droperidol is widely used for the prevention of postoperative nausea and vomiting (PONV) in European countries. It is unclear how efficacious low-dose droperidol is in the prevention of PONV.
OBJECTIVES
To test the efficacy of low-dose droperidol in the prevention of PONV in adults and to test for dose-responsiveness.
DESIGN
Systematic review of randomised controlled trials with meta-analyses.
DATA SOURCES
Comprehensive search in electronic databases (Medline, Embase, Central) up to June 2011. Additional trials were obtained from bibliographies of retrieved reports. No language restriction was applied.
ELIGIBILITY CRITERIA
Randomised trials testing prophylactic intravenous droperidol ≤1 mg or ≤15 μg kg compared with placebo (or no treatment) in adults undergoing general anaesthesia and reporting on PONV.
RESULTS
We analysed 25 trials (2957 patients). Doses varied from 0.25 to 1.0 mg. For prevention of early nausea (within 6 h postoperatively), relative risk (RR) was 0.45 (95% CI, 0.35 to 0.58); number needed to treat (NNT) was 7, 4, and 2 for low, medium and high baseline risk (i.e. control event rate 25, 50, 75%). For prevention of early vomiting, RR was 0.65 (95% CI, 0.57 to 0.74), NNT 11, 6, and 4. For prevention of late nausea (within 24 h), RR was 0.74 (95% CI, 0.62 to 0.87), NNT 15, 8, and 5. For prevention of late vomiting, RR was 0.61 (95% CI, 0.47 to 0.80), NNT 10, 5, and 3. Droperidol decreased the risk of headache but increased the risk of restlessness. For these outcomes there was no evidence of dose-responsiveness. There were no differences in the incidences of sedation or dizziness. Two patients receiving droperidol 0.625 mg had extrapyramidal symptoms. Cardiac toxicity data were not reported.
CONCLUSION
Prophylactic doses of droperidol of 1 mg or below are antiemetic. Because adverse drug reactions are likely to be dose-dependent, there is an argument to stop using doses of more than 1 mg.
Topics: Adult; Antiemetics; Dose-Response Relationship, Drug; Droperidol; Humans; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Statistics as Topic; Treatment Outcome
PubMed: 22488335
DOI: 10.1097/EJA.0b013e328352813f -
Acta Anaesthesiologica Taiwanica :... Mar 2009
Topics: Antiemetics; Droperidol; Haloperidol; Humans; Postoperative Nausea and Vomiting; Treatment Outcome
PubMed: 19318292
DOI: 10.1016/S1875-4597(09)60012-6 -
Anaesthesia and Intensive Care Apr 1998
Topics: Akathisia, Drug-Induced; Droperidol; Humans
PubMed: 9564413
DOI: No ID Found -
Anesthesia and Analgesia Oct 1981
Topics: Adrenal Gland Neoplasms; Droperidol; Humans; Hypertension; Pheochromocytoma
PubMed: 7197486
DOI: No ID Found -
Anaesthesia and Intensive Care Dec 1997
Topics: Adjuvants, Anesthesia; Akathisia, Drug-Induced; Droperidol; Humans; Male
PubMed: 9452863
DOI: No ID Found