From the Guidelines
Droperidol is not recommended as a first-line treatment for nausea due to its potential for QT prolongation and other side effects, as noted in the most recent guidelines 1. Instead, other antiemetic medications such as ondansetron, dexamethasone, and metoclopramide are preferred due to their more favorable safety profiles. When considering droperidol, the following key points should be taken into account:
- Droperidol works by blocking dopamine D2 receptors in the chemoreceptor trigger zone of the brain, with an onset of action within 3-10 minutes and a duration of action of 2-4 hours 1.
- The recommended dose for adults is typically 1.25-2.5 mg intravenously, although higher doses have been used in certain situations 1.
- Important considerations include monitoring for QT prolongation, as droperidol carries a black box warning for this potential cardiac effect, and common side effects such as sedation, hypotension, and extrapyramidal symptoms 1.
- Contraindications include known QT prolongation, history of torsades de pointes, and hypersensitivity to the medication, and lower doses should be considered for elderly patients and those with hepatic or renal impairment 1. However, based on the most recent evidence, droperidol is not the preferred choice for treating nausea due to its potential risks and the availability of safer alternatives 1.
From the FDA Drug Label
Droperidol Injection is indicated to reduce the incidence of nausea and vomiting associated with surgical and diagnostic procedures. Droperidol produces an antiemetic effect as evidenced by the antagonism of apomorphine in dogs It lowers the incidence of nausea and vomiting during surgical procedures and provides antiemetic protection in the postoperative period.
Droperidol is indicated for nausea associated with surgical and diagnostic procedures. The drug has an antiemetic effect and can lower the incidence of nausea and vomiting during and after surgical procedures 2 2.
From the Research
Efficacy of Droperidol for Nausea
- Droperidol is a dopamine D(2) receptor antagonist that has been widely used for the prevention and treatment of postoperative nausea and vomiting (PONV) 3.
- In well-controlled clinical trials, the efficacy of single-dose intravenous (IV) droperidol in preventing PONV was similar to that of ondansetron and dexamethasone 3.
- Droperidol has been found to have equal or greater efficacy in reducing nausea and vomiting than ondansetron and metoclopramide, with similar adverse effects 4.
- A randomized comparison of droperidol, metoclopramide, tropisetron, and ondansetron for the prevention of postoperative nausea and vomiting found that droperidol, tropisetron, and ondansetron were effective in preventing postoperative nausea and vomiting, while metoclopramide was not effective 5.
Safety and Tolerability
- Droperidol is generally well tolerated, and the incidence of adverse effects is similar to that observed with placebo and the serotonin 5-HT(3) receptor antagonists (setrons) 3.
- The most common adverse effects of droperidol include sedation, which was seen in 5 patients receiving droperidol in one study 5.
- Despite a boxed warning issued by the FDA, droperidol seems to be effective and safe when used in low doses in otherwise healthy patients, and does not require routine screening with electrocardiography before administration in the emergency department 4.
Use in Specific Populations
- Guidelines recommend that, in adults, droperidol monotherapy be considered for those at moderate risk of PONV, and droperidol in combination with a setron and/or dexamethasone be considered for patients at moderate or high risk of PONV 3.
- In children with moderate or high risk of PONV, droperidol is recommended for first-line use in some countries, and second-line use in others 3.
- There is insufficient evidence to advise on the use of droperidol for the management of nausea and vomiting in palliative care, as no studies have been found that meet the inclusion criteria for this population 6, 7.