Droperidol: Difference between revisions
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*5-10mg IV | *5-10mg IV | ||
*10mg IM | *10mg IM | ||
===[[Nausea/vomiting]]=== | |||
*0.625-2.5mg IV | |||
===[[Headache]]=== | ===[[Headache]]=== | ||
*2.5mg IV or 2.5-5mg IM | *2.5mg IV or 2.5-5mg IM | ||
===[[ | ===[[Pain (with or without opiate tolerance)]]=== | ||
*0.625- | *0.625-5mg or higher IV/IM<ref>Richards JR, Richards IN, Ozery G, Derlet RW. Droperidol analgesia for opioid-tolerant patients. J Emerg Med. 2011 Oct;41(4):389-96. doi: 10.1016/j.jemermed.2010.07.005. Epub 2010 Sep 15. PMID: 20832967.</ref><ref>Miller AC, Khan AM, Castro Bigalli AA, Sewell KA, King AR, Ghadermarzi S, Mao Y, Zehtabchi S. Neuroleptanalgesia for acute abdominal pain: a systematic review. J Pain Res. 2019;12:787-801 https://doi.org/10.2147/JPR.S187798</ref> | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
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===Common=== | ===Common=== | ||
*Somnolence, dysphoria | *Somnolence, dysphoria, anxiety | ||
* | *'''Akathisia''': restlessness, inability to sit still, distressing disquiet | ||
**Treatable with diphenhydramine (50mg PO/IM/IV) OR benztropine (1-2mg IV) and others<ref>Pringsheim T, Gardner D, Addington D, et al. The Assessment and Treatment of Antipsychotic-Induced Akathisia. Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288</ref><ref>Rice, J. CoreEM.net - Akathisia. https://coreem.net/core/akathisia/ Accessed: Oct 4, 2021.</ref> | |||
*Hypotension | *Hypotension | ||
*Tachycardia | *Tachycardia | ||
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==Comments== | ==Comments== | ||
In my experience akathisia and dystonia are more common in women up to about 30 years old and teenagers of both sexes. I don't use it on anyone younger than 18. Also, there seems to be an association with rate of administration and side-effects. When I order it, I have the nurses put the dose in a 10mL saline flush and give it over a minute. Anecdotally, this seems to decrease the rate of side-effects. When they occur, 50 mg diphenhydramine IVP is my go-to medication, which usually works, though I have had to redose. | |||
It is VERY useful as an adjunct to other pain medications, opiates or otherwise, when you are reaching your comfort level for those meds. | |||
It is far superior to ondansetron for intractable vomiting, especially cannabinoid hyperemesis syndrome, which some readers will use droperidol's sister drug, haloperidol, to treat. | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
*[http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ emDOCs: Droperidol Use in the Emergency Department – What’s Old is New Again] | *[http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ emDOCs: Droperidol Use in the Emergency Department – What’s Old is New Again] | ||
*[https://www.acep.org/ | *[https://www.acep.org/painmanagement/newsroom/may2020/oldie-but-a-goodie-10-pearls-of-droperidol/ ACEP: Oldie but a Goodie: 10 Pearls of Droperidol] | ||
==References== | ==References== | ||
Revision as of 18:50, 5 October 2021
Administration
- Type: antipsychotic, antiemetics
- Dosage Forms: 5mg/2mL
- Routes of Administration: IV/IM
- Common Trade Names: Inapsine
Adult Dosing
Combative patient
- 5-10mg IV
- 10mg IM
Nausea/vomiting
- 0.625-2.5mg IV
Headache
- 2.5mg IV or 2.5-5mg IM
Pain (with or without opiate tolerance)
Pediatric Dosing
Nausea/vomiting
- 2-12yo: 0.015-0.1mg/kg IV/IM
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: Administer with caution
- Hepatic dosing: Administer with caution
Contraindications
- Allergy to class/drug
- Known or suspected prolonged QT
Adverse Reactions
Serious
- Prolonged QT, torsades, ventricular tachycardia, cardiac arrest
- Note: effect on QT interval is dose-dependent
- In 2001, FDA gave black box warning for risk of torsades de pointes, however there was little evidence to support this
- Large cohort of patients in ED showed safety of its administration[3]
- Neuroleptic malignant syndrome
- Anaphylaxis
Common
- Somnolence, dysphoria, anxiety
- Akathisia: restlessness, inability to sit still, distressing disquiet
- Hypotension
- Tachycardia
Pharmacology
- Half-life: 123-147m (adults), 75-127m (children)
- Metabolism: hepatic
- Excretion: mostly renal
Mechanism of Action
- Dopamine (D2) antagonist. Some serotonergic, histaminergic, and α-adrenergic effect
Comments
In my experience akathisia and dystonia are more common in women up to about 30 years old and teenagers of both sexes. I don't use it on anyone younger than 18. Also, there seems to be an association with rate of administration and side-effects. When I order it, I have the nurses put the dose in a 10mL saline flush and give it over a minute. Anecdotally, this seems to decrease the rate of side-effects. When they occur, 50 mg diphenhydramine IVP is my go-to medication, which usually works, though I have had to redose.
It is VERY useful as an adjunct to other pain medications, opiates or otherwise, when you are reaching your comfort level for those meds.
It is far superior to ondansetron for intractable vomiting, especially cannabinoid hyperemesis syndrome, which some readers will use droperidol's sister drug, haloperidol, to treat.
See Also
External Links
- emDOCs: Droperidol Use in the Emergency Department – What’s Old is New Again
- ACEP: Oldie but a Goodie: 10 Pearls of Droperidol
References
- ↑ Richards JR, Richards IN, Ozery G, Derlet RW. Droperidol analgesia for opioid-tolerant patients. J Emerg Med. 2011 Oct;41(4):389-96. doi: 10.1016/j.jemermed.2010.07.005. Epub 2010 Sep 15. PMID: 20832967.
- ↑ Miller AC, Khan AM, Castro Bigalli AA, Sewell KA, King AR, Ghadermarzi S, Mao Y, Zehtabchi S. Neuroleptanalgesia for acute abdominal pain: a systematic review. J Pain Res. 2019;12:787-801 https://doi.org/10.2147/JPR.S187798
- ↑ Gaw CM, Cabrera D, Bellolio F, Mattson AE, Lohse CM, Jeffery MM. Effectiveness and safety of droperidol in a United States emergency department. Am J Emerg Med. 2020;38(7):1310-1314. doi:10.1016/j.ajem.2019.09.007
- ↑ Pringsheim T, Gardner D, Addington D, et al. The Assessment and Treatment of Antipsychotic-Induced Akathisia. Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288
- ↑ Rice, J. CoreEM.net - Akathisia. https://coreem.net/core/akathisia/ Accessed: Oct 4, 2021.