Emergency medicine updates: Droperidol - 11/02/22

Doi : 10.1016/j.ajem.2022.01.011

David Cisewski, MD ^a, Brit Long, MD ^b,^{^⁎,}^{^{1
Present Address: 3841 Roger Brooke Dr. Fort Sam Houston, TX 78234, United States of America.}} , Michael Gottlieb, MD ^c
^a Kaiser Permanente Santa Clara Homestead Medical Center, 700 Lawrence Expwy, Santa Clara, CA, USA
^b Research, SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
^c Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA

^⁎Corresponding author.

Abstract

Introduction

Droperidol is a butyrophenone that has recently been reintroduced after a United States Food and Drug Administration (US FDA) black box warning in 2001. Evidence demonstrates utility in a variety of clinical conditions.

Objective

This paper provides evidence-based updates concerning the use of droperidol for the emergency clinician.

Discussion

Droperidol received a black box warning by the US FDA in 2001 due to concerns for QT prolongation and torsades de pointes; however, reevaluation of the available data suggests droperidol is a safe and efficacious medication. It can be used in the emergency department (ED) setting for many conditions, including acute agitation, headaches, vertigo, nausea, and vomiting. Extensive literature supports that the QT-prolonging effects are transient and that the risk of torsades de pointes is rare with doses utilized in the ED. An electrocardiogram does not need to be routinely obtained before droperidol use but should be considered in patients at high risk for QT prolongation.

Conclusions

Current evidence suggests that droperidol is a safe and effective medication for treating nausea and vomiting, headache, vertigo, and agitation in the ED setting.

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Keywords : Droperidol, Agitation, Pain, Nausea, Headache, vertigo, QT prolongation, Prolonged QT