China
Africa
Explore chapters and articles related to this topic
Pharmacology of Opioids
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The butyrophenones droperidol and haloperidol have both been used for the prevention and treatment of PONV. Both these drugs may cause prolongation of the QT interval, which in rare instances, could lead to torsades de pointes and death. It was because of this risk that the Food and Drug Administration (FDA) in the United States imposed a “black box” warning on droperidol in 2001. However, the effect on QT interval is dose dependent, and it is generally considered that low doses (for example, 0.625 mg or less) are unlikely to pose a risk (Gan et al, 2020). These low doses are also unlikely to lead to sedation, although a further dose reduction in older patients should be considered. In many countries droperidol remains a commonly used, effective, and generally well-tolerated antiemetic agent for parenteral use. Haloperidol is used less often but is also effective antiemetic at low doses. Reports of QT prolongation, torsades de pointes and death associated with use of haloperidol led the FDA to also issue an alert for haloperidol in 2007, but a “black box” warning on the label was not required (Zabirowicz & Gan, 2019).
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Benzodiazepines, particularly the shorter acting midazolam (at various doses by different routes, see above) or, less often now, oral temazepam 1 mg/kg are used. One British group has used chloral hydrate or temazepam and droperidol for neuroimaging sedation [18]. As many as 1094 to 1155 (95%) procedures were judged successful and there were no adverse events relating to airway or breathing (95%, CI 0.35%). Droperidol is a butyrophenone major tranquilliser/neuroleptic, which has also been traditionally used in sedation for AEPs. However, there is a significant risk of it inducing movement disorders, e.g. an oculogyric crisis, typically a few hours after the child has woken up and gone home. It no longer appears in the British National Formulary [19] or Medicines for Children [1].
Moderate Sedation in Dermatologic Surgery
Published in Marwali Harahap, Adel R. Abadir, Anesthesia and Analgesia in Dermatologic Surgery, 2019
Torres Omar, Scarborough Dwight, Bisaccia Emil
Droperidol at a dose of 0.005 to 0.07 mg/kg IV is an effective antiemetic agent because of its anti-dopamine properties. Higher doses are not recommended due to a potential increase in the postoperative sedation and other adverse effects, which can prolong the recovery time (40). Because of stringent FDA warning of droperidol association with sudden death, the drug has been removed from most hospital formularies in the United States.
The utility of droperidol in the treatment of cannabinoid hyperemesis syndrome
Published in Clinical Toxicology, 2019
Carl Lee, Shaun L. Greene, Anselm Wong
Droperidol is an antipsychotic belonging to the butyrophenone class which also includes haloperidol. It is effective when used to treat nausea and vomiting in the ED [10]. In addition, droperidol is often used for postoperative nausea and vomiting with proven efficacy [11]. Droperidol is commonly used in Australia and other parts of the world for acute psychosis, agitation, and as an anti-emetic [12,13]. In December 2001, the United States Food and Drug Administration (FDA) issued a black box warning for droperidol due to the increased risk of QT prolongation and potential dysrhythmia which has limited its use by clinicians in the US [12]. However, larger studies [13,14] demonstrated that droperidol is safe and effective for the treatment of agitation in ED patients. Doses used in these studies (10–20 mg) are much larger than commonly used antiemetic doses. In addition, the development of Torsades des Pointes from prolonged QT is multifactorial.
A Prospective Before and After Study of Droperidol for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2018
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Emma Bosley, Katherine Z. Isoardi, Frances E. Williamson, Geoffrey K. Isbister
Our study has shown that IM droperidol is safer and more effective for the sedation of patients with acute behavioral disturbance in comparison to midazolam in the prehospital setting. In comparison to midazolam, droperidol has a significantly lower rate of adverse events, with only 7% of patients having an adverse effect compared to 23% with midazolam. Time to sedation with droperidol was shorter in comparison to midazolam. The requirement for additional sedation during the prehospital time or within the first hour of arrival to the ED once the patient was sedated was significantly reduced with droperidol. The number of drug administrations was also significantly fewer with droperidol. The rate of failed sedation in patients with acute behavioral disturbance was higher in midazolam group and overall more patients in the droperidol group were successfully sedated. There was no difference in staff or patient injuries or in the total prehospital time.
A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioral Disturbance
Published in Prehospital Emergency Care, 2019
Colin B. Page, Lachlan E. Parker, Stephen J. Rashford, Katherine Z. Isoardi, Geoffrey K. Isbister
In this study of the prehospital management of acute behavioral disturbance in children, we have shown that droperidol appears to be both safe and effective. The incidence of adverse effects is low, with only half of these requiring an intervention. The majority of patients were sedated with one dose of droperidol. These findings are similar to studies of droperidol in adults in the same setting and indicate that droperidol is a proven agent in the drug management of prehospital acute behavioral disturbance.