Is droperidol (antiemetic medication) effective in treating vertigo (benign paroxysmal positional vertigo)?

From the Guidelines

Droperidol is not recommended for the treatment of vertigo due to the lack of evidence supporting its effectiveness and the potential for significant harm. The most recent and highest quality study, a clinical practice guideline published in 2017 1, recommends against the use of vestibular suppressant medications, including droperidol, for the treatment of benign paroxysmal positional vertigo (BPPV). This guideline suggests that these medications are not effective as a definitive, primary treatment for BPPV and may even interfere with more effective treatments such as repositioning maneuvers.

Some key points to consider when evaluating the use of droperidol for vertigo include:

• The lack of evidence supporting the effectiveness of droperidol for vertigo treatment, with studies showing no additional relief compared to placebo 1
• The potential for significant harm, including drowsiness, cognitive deficits, and interference with driving or operating machinery 1
• The increased risk of falls associated with the use of vestibular suppressant medications, particularly in elderly patients 1
• The potential for polypharmacy and additional risk when adding vestibular suppressants to other medications 1

In general, the treatment of vertigo should focus on addressing the underlying cause and using evidence-based treatments such as repositioning maneuvers, vestibular rehabilitation, and selective use of medications like antihistamines or benzodiazepines for short-term management of symptoms. The use of droperidol should be avoided due to its potential risks and lack of evidence supporting its effectiveness.

From the Research

Role of Droperidol in Treating Vertigo

• Droperidol has been studied as a potential treatment for vertigo, with some studies suggesting its effectiveness in reducing symptoms 2, 3, 4.
• A study from 1983 reported the results of using droperidol as the sole form of therapy in 21 patients with vertigo related to inner ear disease, discussing its pharmacology, dosage techniques, and necessary precautions 2.
• Another study from 2002 compared the efficacy of intramuscular droperidol with intramuscular dimenhydrinate in treating acute peripheral vertigo in the emergency department, finding no difference between the two treatments 3.
• A 1976 study found that droperidol was effective in depressing vestibular disturbance regardless of etiology, with significant responses to Inapsine in a double-blind study 4.

Comparison with Other Treatments

• A 2019 study compared the effectiveness of ondansetron and promethazine in treating acute peripheral vertigo, finding that promethazine was more effective in reducing vertigo, while ondansetron was more effective in reducing nausea 5.
• A 2023 clinical review of droperidol use in the emergency department found that it is an effective sedative, anxiolytic, analgesic, and antiemetic medication, with equal or greater efficacy than ondansetron and metoclopramide in reducing nausea and vomiting 6.

Efficacy and Safety

• The 2023 clinical review also found that droperidol seems to be effective and safe, despite the boxed warning issued by the FDA, and does not require routine screening with electrocardiography when used in low doses in otherwise healthy patients 6.
• The review suggested that droperidol is a powerful antiemetic, sedative, anxiolytic, antimigraine, and adjuvant to opioid analgesia, and can be a useful adjunct in patients who are opioid-tolerant 6.