What is the recommended dose and management of droperidol (antiemetic) for nausea and vomiting?

From the Guidelines

The recommended dose of droperidol for managing nausea and vomiting is 1.25 to 2.5 mg given intravenously, as stated in the most recent and highest quality study 1.

Key Considerations

• The onset of action is 3 to 10 minutes, and the duration of effect is 2 to 4 hours 1.
• Droperidol is used as an adjunct to standard sedation for complex endoscopic procedures or difficult-to-sedate patients such as alcoholics and long-term drug abusers 1.
• Important side effects include hypotension, prolongation of the QTc interval, and extrapyramidal signs 1.

Patient Selection and Monitoring

• Droperidol use is contraindicated in patients with a prolonged QTc interval (440 ms in males, 450 ms in females) and should be avoided in patients at increased risk of the development of QT interval prolongation 1.
• An ECG should be obtained before administration in patients with risk factors for QT prolongation 1.
• The medication should be avoided in patients with known QT prolongation or those taking other medications that prolong the QT interval 1.

Dosing and Administration

• The usual dose of droperidol for endoscopic sedation is 1.25 to 2.5 mg intravenously, although higher doses have been used 1.
• A dose reduction is recommended in patients with renal or liver disease 1.

Clinical Evidence

• Studies have shown that droperidol is effective in achieving adequate sedation for upper endoscopy, although 24% of patients experienced transient hypotension 1.
• Sedation with fentanyl/droperidol was assessed to be better than the diazepam/fentanyl combination in difficult-to-sedate patients 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized. Some of the factors to be considered in determining the dose are age, body weight, physical status, underlying pathological condition, use of other drugs, type of anesthesia to be used, and the surgical procedure involved. Adult Dosage: The maximum recommended initial dose of droperidol is 2. 5 mg IM or slow IV. Additional 1.25 mg doses of droperidol may be administered to achieve the desired effect. Children’s Dosage: For children two to 12 years of age, the maximum recommended initial dose is 0. 1 mg/kg, taking into account the patient's age and other clinical factors.

The recommended dose of droperidol for nausea and vomiting is:

• Adults: Initial dose of 2.5 mg IM or slow IV, with additional 1.25 mg doses as needed
• Children (2-12 years): Initial dose of 0.1 mg/kg, taking into account the patient's age and other clinical factors Key considerations:
• Dosing should be individualized based on factors such as age, body weight, and physical status
• Additional doses should be administered with caution, only if the potential benefit outweighs the potential risk 2

From the Research

Droperidol Dosing for Nausea and Vomiting

• The recommended dose of droperidol for the management of nausea and vomiting is not explicitly stated in the provided studies, but its efficacy and safety are discussed in various clinical settings 3, 4, 5, 6.
• Droperidol is a dopamine D(2) receptor antagonist that has been widely used for the prevention and treatment of postoperative nausea and vomiting (PONV) and opioid-induced PONV during patient-controlled analgesia (PCA) in adults 3.
• In adults, droperidol monotherapy may be considered for those at moderate risk of PONV, and droperidol in combination with a setron and/or dexamethasone may be considered for patients at moderate or high risk of PONV 3.
• A study comparing different antiemetic drugs found that droperidol had a statistically significant change in baseline visual analogue scale (VAS) for nausea severity from baseline to 30 minutes, with a mean difference of -15.8 4.
• Droperidol has been found to have equal or greater efficacy in reducing nausea and vomiting than ondansetron and metoclopramide, with similar adverse effects 5.
• The medication is considered safe and effective for use in the emergency department setting, with no need for routine electrocardiography screening before administration in low doses in otherwise healthy patients 5, 6.

Management of Droperidol

• Droperidol can be used in the emergency department setting for various conditions, including acute agitation, headaches, vertigo, nausea, and vomiting 6.
• The QT-prolonging effects of droperidol are considered transient, and the risk of torsades de pointes is rare with doses utilized in the emergency department 6.
• An electrocardiogram should be considered in patients at high risk for QT prolongation before droperidol use 6.
• Current evidence suggests that droperidol is a safe and effective medication for treating nausea and vomiting, headache, vertigo, and agitation in the emergency department setting 6.