What is the recommended dose of droperidol (antipsychotic) for acute behavioral disturbance?

From the Guidelines

The recommended dose of droperidol for acute behavioral disturbance in adults is typically 5 mg intramuscularly (IM) or 2.5 mg intravenously (IV), with the possibility of repeating the dose after 30-60 minutes if needed, as supported by a class II study by Richards et al 1.

Key Considerations

• Before administration, it's essential to obtain baseline vital signs and cardiac monitoring due to droperidol's risk of QT prolongation.
• The medication typically begins working within 10-30 minutes and lasts 3-6 hours.
• Patients should be monitored for side effects including hypotension, extrapyramidal symptoms, and sedation.
• Droperidol works by blocking dopamine D2 receptors in the brain, which helps reduce agitation and psychotic symptoms.
• It should be used cautiously in patients with cardiac conditions, electrolyte abnormalities, or those taking other QT-prolonging medications, as noted in the FDA black box warning 1.

Safety Precautions

• Having resuscitation equipment readily available during administration is recommended as a safety precaution.
• The risk of QT prolongation and cardiac events associated with droperidol has been disputed by several studies, including a large retrospective review of 2468 patients given droperidol in the ED, which found no cardiovascular event occurred that did not have an alternative explanation 1.
• However, it is still crucial to use droperidol with caution and monitor patients closely for any adverse effects.

Dosing Considerations

• For elderly patients or those with compromised health, starting with a lower dose of 1.25-2.5 mg is advisable.
• The dose of droperidol may need to be adjusted based on the patient's response and the presence of any side effects.
• As noted in a study on the use of droperidol for endoscopic sedation, the usual dose of droperidol is 1.25 to 2.5 mg intravenously, although higher doses have been used 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized. ... 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. The recommended dose of droperidol for acute behavioral disturbance is:

• Initial dose: 2.5 mg IM or slow IV
• Additional doses: 1.25 mg, administered with caution, only if the potential benefit outweighs the potential risk 2

From the Research

Recommended Dose of Droperidol for Acute Behavioral Disturbance

The recommended dose of droperidol for acute behavioral disturbance varies depending on the patient population and setting.

• For adults, a dose of 10 mg of droperidol has been used in some studies 3, while others have used a dose of 5 mg 4.
• For children, a dose of 0.1-0.2 mg/kg of droperidol has been used 5.
• For elderly patients, an initial dose of 5 mg of droperidol may be prudent, with the expectation that many will require another dose 4.

Efficacy and Safety of Droperidol

• Droperidol has been shown to be effective in managing acute behavioral disturbance in various patient populations, including adults 3, children 5, and elderly patients 4.
• The safety of droperidol has been evaluated in several studies, with most finding that it is safe and effective when used appropriately 3, 5, 6, 4, 7.
• However, droperidol carries a risk of QT prolongation and torsades de pointes, although the incidence of these events is rare 7.

Considerations for Use

• The use of droperidol should be individualized based on the patient's condition and medical history.
• Close monitoring of the patient's vital signs and electrocardiogram (ECG) is recommended, especially in high-risk patients 7.
• The dose and frequency of droperidol administration should be adjusted based on the patient's response to treatment and the presence of any adverse effects.