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Droperidol Injection - Uses, Dose, Side effects, MOA, Brands

Droperidol is a medication primarily used as an antiemetic (to prevent nausea and vomiting) and as a tranquilizer. It belongs to the butyrophenone class of antipsychotic drugs. Droperidol works by blocking the dopamine receptors in the brain, which helps to alleviate symptoms of nausea and vomiting, and also produces sedation and tranquilization.

In addition to its antiemetic properties, droperidol has been used off-label for the management of acute psychotic episodes and agitation, though its use in this context has declined due to concerns about potential side effects, particularly cardiac arrhythmias.

Droperidol is a butyrophenone that has got antiemetic, antianxiety, and antipsychotic properties. It is indicated for postoperative nausea and vomiting and sedation in the intensive care unit.

Droperidol Uses:

Postoperative nausea and vomiting (PONV):
- For prevention and/or treatment of nausea and vomiting after surgical and diagnostic procedures
Off Label Use of Droperidol in Adults:
- Acute undifferentiated agitation

Droperidol Dose in adults:

Note: Titrate carefully until the desired effect is acheived

Droperidol Dose in the treatment of Acute undifferentiated agitation (off-label):

When treating acute undifferentiated agitation (which means sudden and unexplained restlessness or excitement), droperidol can be given either as a shot in the muscle (intramuscular) or directly into a vein (intravenous).

For intramuscular use, the initial dose is usually between 5 to 10 milligrams. This can be given alone or with a benzodiazepine, another type of medication. If more medication is needed after giving droperidol, it's recommended to wait at least 10 to 30 minutes before adding more.
If given intravenously, the initial dose is also between 2.5 to 10 milligrams. Again, this can be given alone or with a benzodiazepine. The dose can be repeated every 5 minutes until the person becomes calm or sedated. However, the maximum total dose for one episode is 20 milligrams. In most cases, the average needed dose is around 10 milligrams.

Droperidol Dose in the treatment of Postoperative nausea and vomiting (PONV): IM, IV:

For postoperative nausea and vomiting (PONV), droperidol can be given either as a shot in the muscle (intramuscular) or directly into a vein (intravenous).

According to the manufacturer's instructions, the maximum initial dose is 2.5 milligrams. Additional doses of 1.25 milligrams may be given cautiously if needed to achieve the desired effect.

Consensus guideline recommendations suggest a lower initial dose of 0.625 to 1.25 milligrams given intravenously at the end of surgery.

Droperidol Dose in Children:

Dosage must be customized according to age, body weight, underlying comorbid conditions, physical status, concomitant medications, type of anesthesia, and surgical procedure.

Droperidol Dose in the treatment of Postoperative nausea and vomiting (PONV):

For the prophylaxis (prevention) of postoperative nausea and vomiting (PONV) in individuals at high risk:

Children aged 2 years and older, as well as adolescents:
- The recommended dose is 0.01 to 0.015 milligrams per kilogram of body weight, given either by injection into the muscle (intramuscular) or directly into a vein (intravenous) near the end of surgery.
- The maximum dose per administration is 1.25 milligrams.
- Additional doses can be administered cautiously after at least 6 hours, but only if the potential benefits outweigh the risks.
- Higher doses, such as 0.075 milligrams per kilogram, were previously used, but due to associated side effects, doses exceeding 0.05 milligrams per kilogram are now considered excessive and are no longer recommended.

For treatment, if droperidol is not the first-line option:

Children aged 2 to 12 years:
- The maximum initial dose is 0.1 milligrams per kilogram of body weight, given either intramuscularly or intravenously.
- Additional doses should be administered with extreme caution and only if the potential benefits outweigh the risks.

Pregnancy Risk Factor: C

Droperidol has a pregnancy risk factor C, meaning it might pose risks to a developing fetus based on animal studies where adverse events were observed.
While it's been studied for helping with severe nausea and vomiting during pregnancy, known as hyperemesis gravidarum, it's not recommended for treating ongoing nausea and vomiting during pregnancy because of potential risks to both the mother and the baby.

Use droperidol while breastfeeding

It's uncertain whether droperidol passes into breast milk.
Some studies have noted adverse effects in breastfed babies whose mothers received droperidol during cesarean delivery, but more research is required to fully understand the risks.
There's a theoretical concern that droperidol might affect milk production.
However, based on limited data, exposure of a breastfed infant to droperidol after a single maternal dose is not expected to cause significant harm.
Nonetheless, caution is advised when using droperidol in breastfeeding women, as more research is needed to better understand its effects on breastfeeding infants.

Dose in Kidney disease:

The manufacturer's labeling does not provide specific dosage adjustments for droperidol in individuals with renal impairment.
However, caution should be exercised when using droperidol in patients with renal impairment.
This caution is because the drug may be cleared from the body more slowly in individuals with kidney problems, potentially leading to an increased risk of side effects.

Dose in Liver disease:

The manufacturer's labeling does not include specific dosage adjustments for droperidol in individuals with hepatic impairment.
However, caution should be exercised when administering droperidol to patients with liver problems.
Hepatic impairment can affect the metabolism and elimination of drugs from the body, potentially leading to altered drug levels and increased risk of side effects.

Side effects of Droperidol:

Cardiovascular:
- Cardiac Arrest
- Hypertension
- Hypotension (Especially Orthostatic)
- QT Prolongation (Dose-Dependent)
- Tachycardia
- Torsade De Pointes
- Ventricular Tachycardia
Central Nervous System:
- Anxiety
- Chills
- Depression (Postoperative
- Transient)
- Dizziness
- Drowsiness (Postoperative) Increased
- Dysphoria
- Extrapyramidal Symptoms (Akathisia
- Dystonia
- Oculogyric Crisis)
- Hallucinations (Postoperative)
- Hyperactivity
- Neuroleptic Malignant Syndrome (NMS) (Rare)
- Restlessness
Respiratory:
- Bronchospasm
- Laryngospasm
Miscellaneous:
- Anaphylaxis
- Shivering

Contraindications to Droperidol:

Droperidol should not be used in individuals who have a known hypersensitivity to droperidol or any component of its formulation.
It is also contraindicated in individuals with known or suspected QT prolongation, including congenital long QT syndrome.
QT prolongation refers to abnormal prolongation of the QT interval on an electrocardiogram, and it's considered significant if it exceeds 440 milliseconds in males or 450 milliseconds in females.
Additionally, Canadian labeling specifies that droperidol should not be used in children younger than 2 years of age, although this contraindication is not present in US labeling.
These contraindications are important to consider to ensure the safe use of droperidol and to avoid potential adverse effects in susceptible individuals.

Warnings and precautions

Arrhythmias: [US Boxed Warning]:

Droperidol carries a Boxed Warning in the United States due to reported cases of QT prolongation and torsades de pointes, some of which have been fatal.
Extreme caution is advised when using droperidol, especially in patients with conditions such as bradycardia (heart rate less than 50 beats per minute), existing cardiac disease, or those taking medications known to prolong the QT interval (such as certain antiarrhythmics or MAO inhibitors).
Electrolyte disturbances like low levels of potassium or magnesium, as well as concurrent use of drugs that affect electrolyte levels (like diuretics), should also be carefully considered.
Monitoring for any signs of arrhythmias or QT prolongation is crucial when using droperidol in these patients to minimize the risk of serious adverse events.

Anticholinergic effects

Droperidol can potentially lead to anticholinergic effects, which may include constipation, dry mouth (xerostomia), blurred vision, and urinary retention.
It's important to use droperidol cautiously in patients with conditions such as decreased gastrointestinal motility, urinary retention, benign prostatic hyperplasia (BPH), dry mouth, or visual problems.
Compared to other similar medications, droperidol has a relatively low potency in blocking cholinergic receptors.

CNS depression:

Droperidol can lead to central nervous system (CNS) depression, potentially affecting both physical and mental abilities.
Patients should be advised to exercise caution when performing tasks that require mental alertness, such as operating machinery or driving vehicles.
It's important for healthcare providers to inform patients about these potential effects of droperidol and to emphasize the importance of avoiding activities that could be unsafe while under its influence.

Aspiration and esophageal dysmotility:

The use of antipsychotic medications like droperidol has been linked to esophageal dysmotility and the risk of aspiration, especially in older adults.
This risk is particularly heightened in patients with conditions that predispose them to aspiration pneumonia, such as Alzheimer's disease.

Extrapyramidal symptoms:

Droperidol may lead to extrapyramidal symptoms (EPS), such as pseudo-parkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia.
However, the risk of these reactions is generally lower compared to typical or conventional antipsychotic medications, and frequencies reported are similar to those observed with placebo.
Factors that may increase the risk of EPS, particularly dystonia, include higher doses, the use of conventional antipsychotics, male gender, and younger age.
Certain factors, like older age, female gender combined with postmenopausal status, Parkinson's disease, previous brain damage, and high doses of antipsychotics, may make individuals more vulnerable to tardive dyskinesia.
If signs or symptoms of tardive dyskinesia appear, therapy discontinuation should be considered.

Hyperprolactinemia:

Droperidol use may lead to increased levels of prolactin, a hormone involved in milk production.
The clinical significance of this hyperprolactinemia in patients with conditions such as breast cancer or other prolactin-dependent tumors is not fully understood.
While studies have investigated this phenomenon, the implications for patients with such conditions remain unclear.

Neuroleptic malignant syndrome (NMS):

The use of droperidol may be associated with neuroleptic malignant syndrome (NMS), a rare but serious condition characterized by mental status changes, fever, muscle rigidity, and autonomic instability.

Orthostatic hypotension

Droperidol may lead to orthostatic hypotension, a drop in blood pressure when standing up from a sitting or lying position.
This effect can be risky for patients with conditions such as cerebrovascular disease, cardiovascular disease, hypovolemia, or those taking medications that could increase the risk of hypotension or bradycardia.

Temperature regulation

Droperidol can impair the regulation of core body temperature, potentially leading to difficulties in maintaining normal body temperature.
Patients should be cautious when engaging in strenuous exercise, exposure to heat, or situations that may lead to dehydration, as these factors can exacerbate temperature regulation issues.
Additionally, caution is advised when using droperidol alongside medications that have anticholinergic effects, as these can further interfere with temperature regulation.

Hepatic impairment

Droperidol should be used with caution in patients with severe hepatic impairment, a condition where the liver function is significantly compromised.
Since droperidol is metabolized in the liver, impaired liver function can affect its clearance from the body, potentially leading to increased drug levels and a higher risk of adverse effects.

Pheochromocytoma:

Droperidol should be used cautiously in patients with pheochromocytoma, a rare tumor of the adrenal glands that can cause excessive release of catecholamines, leading to severe hypertension (high blood pressure) and tachycardia (rapid heart rate).
Administration of droperidol in such patients may exacerbate these symptoms due to its potential to block dopamine receptors and alter catecholamine levels.

Renal impairment

Droperidol should be used with caution in patients with renal impairment, a condition characterized by decreased kidney function.
Since droperidol is eliminated from the body primarily through the kidneys, impaired renal function can affect its clearance, potentially leading to increased drug levels and a higher risk of adverse effects.

Seizures:

Droperidol should be used cautiously in patients who are at risk of seizures, including those with a history of seizures, head trauma, brain damage, alcoholism, or those receiving concurrent therapy with medications that may lower the seizure threshold.
Administration of droperidol in these individuals may potentially increase the risk of seizures.

Droperidol: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Acetylcholinesterase inhibitors	Anticholinergic Agents may have a decreased therapeutic effect. Anticholinergic Agents can decrease the therapeutic effects of Acetylcholinesterase inhibitors.
Inhibitors of Acetylcholinesterase (Central)	Antipsychotic Agents may increase the neurotoxic (central), effect. Some patients have experienced severe extrapyramidal symptoms.
Alizapride	CNS Depressants may increase the CNS depressant effects.
Amifampridine	Agents with Seizure Threshold Lower Potential can enhance the neuroexcitatory or seizure-potentiating effects of Amifampridine.
Amphetamines	Antipsychotic Agents can reduce the stimulatory effects of Amphetamines.
Anticholinergic Agents	Other Anticholinergic Agents may have an adverse/toxic effect.
Botulinum Toxin-Containing Products	Anticholinergic Agents may have an enhanced anticholinergic effect.
Brimonidine (Topical)	CNS Depressants may increase the CNS depressant effects.
BuPROPion	May increase the neuroexcitatory or seizure-potentiating effects of Agents With Seizure Threshold Lowering Potential.
Cannabidiol	CNS Depressants may increase the CNS depressant effects.
Cannabis	CNS Depressants may increase the CNS depressant effects.
Chlorphenesin Carbamate	CNS Depressants may have an adverse/toxic effect that can be exacerbated by them.
Clarithromycin	QT-prolonging Antipsychotics may increase Clarithromycin's QTc-prolonging effects (Moderate risk). When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
CloZAPine	CloZAPine may increase the QTc prolonging effects by QT-prolonging antipsychotics (Moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Dimethindene (Topical).	CNS Depressants may increase the CNS depressant effects.
Dronabinol	CNS Depressants may increase the CNS depressant effects.
Gastrointestinal Agents (Prokinetic)	Anticholinergic Agents can reduce the therapeutic effects of Gastrointestinal Agents (Prokinetic).
Glucagon	Anticholinergic agents may increase the toxic/adverse effects of Glucagon. Particularly, there may be an increase in the likelihood of gastrointestinal adverse reactions.
Guanethidine	Guanethidine's therapeutic effects may be diminished by antipsychotic agents.
Haloperidol	QT-prolonging antipsychotics (Moderate risk) can increase the QTc prolonging effect of Haloperidol. When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Itopride	Itopride's therapeutic effects may be diminished by anticholinergic agents.
Kava Kava	CNS Depressants may have an adverse/toxic effect that can be exacerbated by them.
Lithium	Antipsychotic Agents may have a neurotoxic effect that can be increased by lithium. The serum concentrations of Antipsychotic Agents may be decreased by lithium. Particularly noted for chlorpromazine.
Magnesium Sulfate	CNS Depressants may increase the CNS depressant effects.
Methylphenidate	Antipsychotic Agents can increase the harmful/toxic effects of Methylphenidate. Antipsychotic Agents may have an adverse/toxic effect that is magnified by Methylphenidate.
MetyroSINE	Droperidol may have an adverse/toxic effect.
Minocycline	CNS Depressants may increase the CNS depressant effects.
Mirabegron	Anticholinergic agents may increase the toxic/adverse effects of Mirabegron.
Nabilone	CNS Depressants may increase the CNS depressant effects.
Nitroglycerin	The absorption of Nitroglycerin may be decreased by anticholinergic agents. Anticholinergic Agents may reduce the dissolution sublingual nitroglycerin tablet, which could impair or slow down nitroglycerin absorbtion.
Ondansetron	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Pentamidine (Systemic)	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Antidepressants (Moderate risk)	QT-prolonging antipsychotics (Moderate risk) can increase the QTc prolonging effect QT-prolonging antidepressants (Moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Antipsychotics (Moderate Risk)	Droperidol may increase the QTc-prolonging effects. When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors. Exceptions: Amisulpride; CloZAPine; Droperidol; Pimozide.
QT-prolonging Class IC Antiarrhythmics (Moderate Risk)	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Kinase Inhibitors (Moderate Risk)	QT-prolonging antipsychotics (Moderate risk) can increase the QTc prolonging effect QT-prolonging kinase inhibitors (Moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
QT-prolonging Miscellaneous Agents (Moderate Risk)	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors. Domperidone is an exception.
QT-prolonging Moderate CYP3A4 Drug Inhibitors (Moderate risk)	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Quinolone Antibiotics for QT-prolonging (Moderate risk)	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Quinagolide	Quinagolide's therapeutic effects may be diminished by antipsychotic agents.
Ramosetron	Ramosetron's constipating effects may be enhanced by anticholinergic agents.
Rufinamide	CNS Depressants may have an adverse/toxic effect that can be exacerbated by this. Particularly, dizziness and sleepiness may be increased.
Saquinavir	QT-prolonging antipsychotics (Moderate risk) can increase the QTc prolonging effects of Saquinavir. When using these agents together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Selective Serotonin Reuptake inhibitors	CNS Depressants can increase the toxic/adverse effects of Selective Serotonin Resuptake Inhibitors. Particularly, psychomotor impairment could be increased.
Serotonin Modulators	Antipsychotic Agents may have an adverse/toxic effect that can be exacerbated by serotonin modulators. Serotonin modulators, in particular, may increase dopamine blockade and possibly increase the risk of neuroleptic malignant syndrome. Serotonin modulators may have a serotonergic effect that is enhanced by antipsychotic agents. This could lead to serotonin syndrome. Nicergoline is an exception.
Tetrahydrocannabinol	CNS Depressants may increase the CNS depressant effects.
Tetrahydrocannabinol, and Cannabidiol	CNS Depressants may increase the CNS depressant effects.
Thiazide and Thiazide - Like Diuretics	Anticholinergic Agents can increase serum Thiazide or Thiazide-Like Diuretics.
Voriconazole	QTc-prolonging effects of QT-prolonging antipsychotics may be increased (moderate risk). When these agents are used together, monitor for QTc interval prolongation or ventricular arrhythmias. Patients at higher risk for QTc prolongation might have additional risk factors.
Risk Factor D (Consider therapy modifications)
Anti-Parkinson Agents (Dopamine Agonist).	Antipsychotic Agents [First Generation] may decrease the therapeutic effect Anti-Parkinson Agents ("Dopamine Agonist") Anti-Parkinson Agents, Dopamine Agonist, may decrease the therapeutic effect Antipsychotic Agents First Generation [Typical]. If possible, avoid concomitant therapy and watch for decreased effects of both agents if they cannot be avoided. AntiParkinson agents may not be affected by atypical antipsychotics like quetiapine or clozapine.
Blonanserin	CNS Depressants can increase the CNS depressant effects of Blonanserin.
Buprenorphine	CNS Depressants can increase the CNS depressant effects of buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Buprenorphine patches (Butrans) should be initiated at 5 mg/hr for adults who are taking other CNS depressants.
Chlormethiazole	CNS Depressants may increase the CNS depressant effects. Monitoring: Look out for signs of CNS depression. If a combination of chlormethiazole and other drugs is required, a reduced dose should be used.
ChlorproMAZINE	Droperidol could increase the CNS depressant effects of ChlorproMAZINE. Droperidol could increase the QTc-prolonging effects of ChlorproMAZINE. Management: You may consider other combinations of this drug. Dose reductions are advised if the drug combination is combined. You should monitor for additive toxicities like QTc interval prolongation and ventricular arrhythmias.
CNS Depressants	Droperidol can increase the CNS depressant effects of CNS Depressants. Droperidol and other CNS agents, such as opioids, may be reduced or combined with droperidol. Separate drug interaction monographs provide more detail on exceptions to this monograph. Exceptions: ChlorproMAZINE, CloZAPine, Flupentixol and Haloperidol; Methadone. OLANZapine. QUEtiapine. RisperiDONE. Thioridazine.
Domperidone	QT-prolonging agents (moderate risk) could increase the QTc-prolonging effects of Domperidone. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation or ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.
Flunitrazepam	CNS Depressants can increase the CNS depressant effects of Flunitrazepam.
HYDROcodone	CNS Depressants can increase the CNS depressant effects of HYDROcodone. When possible, avoid concomitant use with hydrocodone and other CNS depressants. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Iohexol	Agents with Seizure Threshold Lowering Potential can increase the toxic/adverse effects of Iohexol. The risk of seizures could be elevated. Management: Stop using agents that lower the seizure threshold 48 hrs before you start intrathecal iohexol. To resume these agents, wait at least 24 hours following the procedure. Consider using prophylactic anticonvulsants in non-elective procedures.
Iomeprol	Agents with Seizure Threshold Lowering Potential can increase the toxic/adverse effects of Iomeprol. The risk of seizures could be elevated. Management: Stop using agents that lower the seizure threshold 48 hrs before you start intrathecal iomeprol. To resume these agents, wait at least 24 hours following the procedure. Consider using prophylactic anticonvulsants in non-elective procedures.
Iopamidol	Agents with Seizure Threshold Lowering Potential can increase the toxic/adverse effects of Iopamidol. The risk of seizures could be elevated. Management: Stop using agents that lower the seizure threshold 48 hrs before you start intrathecal iopamidol. To resume these agents, wait at least 24 hours following the procedure. Consider using prophylactic anticonvulsants in non-elective procedures.
Mequitazine	Antipsychotic Agents can increase the arrhythmogenic effects of Mequitazine. Management: If you are unable to use one of these agents, consider alternatives. This combination is not contraindicated but mequitazine labels it as discouraged.
Methadone	Methadone's CNS depressant effects may be enhanced by Droperidol. Methadone's QTc-prolonging effects may be enhanced by Droperidol. You should consider other options. Dose reductions are recommended if the doses are combined. You should monitor for additive toxicities like QTc interval prolongation and ventricular arrhythmias. Patients at higher risk for additional risk factors are even more vulnerable.
Methotrimeprazine	Methotrimeprazine may have a higher CNS depressant activity than CNS Depressants. Methotrimeprazine can increase the CNS depressant effects of CNS Depressants. Management: Lower the adult dose of CNS Depressants by 50% and start concomitant methotrimeprazine treatment. After clinically proven efficacy of methotrimeprazine, further CNS depressant dose adjustments should only be made.
OxyCODONE	CNS Depressants can increase OxyCODONE's CNS depressant effects. When possible, avoid the simultaneous use of oxycodone, benzodiazepines, or other CNS depression drugs. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Perampanel	CNS Depressants may have a greater CNS depressant effect. Perampanel and any other CNS depressant drug should be used in combination. Patients who take perampanel together with any other drug should not engage in complex or high-risk activities until they have had experience using the combination.
Pramlintide	Anticholinergic Agents may have an enhanced anticholinergic effect. These effects are only for the GI tract.
Agents that prolong QT (Highest risk)	Droperidol may increase the QTc-prolonging effects. Management: Look for alternatives to this combination. These toxicities are more likely to occur in patients with other risk factors, such as older age, female sexual activity, bradycardia and hypokalemia. There are exceptions to this rule: Methadone, ChlorproMAZINE and Ziprasidone.
Secretin	Secretin's therapeutic effects may be diminished by anticholinergic agents. Concomitant use: Secretin and anticholinergic agents should be avoided. Stop using anticholinergic drugs for at least five half-lives before administering secretin.
Sodium Oxybate	CNS Depressants may have a greater depressant effect if taken in combination. Management: Look for alternatives to the combination use. If you must combine use, reduce the doses of any one or more drugs. It is not recommended to combine sodium oxybate and alcohol, or any sedative hypnotics.
Suvorexant	CNS Depressants can increase the CNS depressant effects of Suvorexant. Management: Suvorexant or any other CNS depressionant can be reduced in doses. Suvorexant should not be taken with alcohol. It is also not recommended to take suvorexant along with any other drugs for insomnia.
Tapentadol	CNS Depressants may increase the CNS depressant effects. Tapentadol, benzodiazepines and other CNS depressants should be avoided when possible. Combining these agents is not recommended unless there are other options. Limit the amount and duration of each drug when combined.
Thiopental	Thiopental may have a therapeutic effect that dropseridol can enhance. Thiopental dosage reduction should be considered when combined with droperidol. If you use this combination, monitor patient responses to treatment.
Zolpidem	CNS Depressants can increase the CNS depressant effects of Zolpidem. Management: For men who also take CNS depressants, reduce the adult Intermezzo brand sublingual Zolpidem dose to 1.75mg. For women, no dose adjustment is advised. Avoid using CNS depressants at night; do not use alcohol.
Risk Factor X (Avoid Combination)
Aclidinium	Anticholinergic Agents may have an enhanced anticholinergic effect.
Amisulpride	Antipsychotic agents may increase the toxic/adverse effects of Amisulpride. Management: The drug interactions monographs for drugs listed as an exception to this monograph provide more information.
Amisulpride	May increase the QTc prolonging effect of QT Prolonging Antipsychotics (Moderate risk).
Azelastine (Nasal)	CNS Depressants could increase the CNS depressant effects of Azelastine.
Bromopride	Bromopride may have an adverse/toxic effect that Droperidol can increase.
Bromperidol	CNS Depressants may increase the CNS depressant effects.
Cimetropium	Cimetropium may have an anticholinergic effect that can be enhanced by the use of anticholinergic agents.
Eluxadoline	Eluxadoline may cause constipation by using anticholinergic agents.
Glycopyrrolate (Oral Inhalation)	Anticholinergic agents may increase the anticholinergic effects of Glycopyrrolate (Oral inhalation).
Glycopyrronium (Topical)	Anticholinergic Agents may have an enhanced anticholinergic effect.
Oral Inhalation with Ipratropium	Anticholinergic Agents may have an enhanced anticholinergic effect.
Levosulpiride	Anticholinergic Agents can reduce the therapeutic effects of Levosulpiride.
Metoclopramide	Metoclopramide may be more toxic or adversely affected by Droperidol.
Orphenadrine	Orphenadrine may be more effective against CNS depression than other drugs.
Oxatomide	Anticholinergic Agents may have an enhanced anticholinergic effect.
Oxomemazine	CNS Depressants may increase the CNS depressant effects.
Paraldehyde	Paraldehyde may be enhanced by CNS depressants.
Pimozide	QTc-prolonging agents may have a moderate risk of increasing their QTc-prolonging effects (Moderate risk).
Piribedil	Antipsychotic Agents can reduce the therapeutic effects of Piribedil. Antipsychotic Agents may have a lower therapeutic effect due to Piribedil. Management: Piribedil is not recommended for use with antiemetic or antipsychotic neuroleptics.
Potassium Chloride	Potassium Chloride may have an ulcerogenic effect that can be exacerbated by anticholinergic agents. Treatment: Patients taking drugs that have significant anticholinergic effects should not consume any oral dose form of potassium chloride.
Potassium Citrate	Potassium Citrate may be more ulcerogenic if it is given to anticholinergic agents.
Revefenacin	Revefenacin may be enhanced by anticholinergic agents.
Sulpiride	Sulpiride's toxic/adverse effects may be exacerbated by antipsychotic agents.
Thalidomide	CNS Depressants can increase Thalidomide's CNS depressant effects.
Tiotropium	Anticholinergic agents may increase the anticholinergic effects of Tiotropium.
Umeclidinium	Anticholinergic Agents may have an enhanced anticholinergic effect.
Ziprasidone	Ziprasidone may have a higher QTc-prolonging effects if Droperidol is added. Management: Look for alternatives to this combination. Monitor for QTc interval prolongation and ventricular arrhythmias if the drug combination is combined. Patients at higher risk for QTc prolongation might have additional risk factors.

Monitoring parameters:

Identifying QT Prolongation:

Before Use: It's recommended to conduct a 12-lead ECG (electrocardiogram) to check for QT prolongation before starting droperidol.
During Administration: Continued monitoring with ECG for 2-3 hours after administration is advised to watch for any changes.

Monitoring Vital Signs and Electrolytes:

Vital Signs: Regularly monitor vital signs like heart rate and blood pressure.
Serum Magnesium and Potassium: Check levels of magnesium and potassium in the blood, as imbalances can affect heart function.
Mental Status and Abnormal Movements:
- Assess mental status to detect any changes in consciousness or behavior.
- Use the Abnormal Involuntary Movement Scale (AIMS) to monitor for any abnormal movements.

Observation for Side Effects:

Dystonias: Watch for muscle contractions that cause twisting or repetitive movements, especially in the face, neck, or limbs.
Extrapyramidal Side Effects: Monitor for symptoms like tremors, rigidity, and restlessness.
Temperature Changes: Keep an eye on body temperature, as droperidol can affect temperature regulation.

How to administer Droperidol?

IM or IV: Droperidol can be administered either intramuscularly (IM) or intravenously (IV), depending on the clinical situation and patient's condition.

IV Push Administration:

Slow IV Push: When administering droperidol via IV push, it's important to do so slowly to reduce the risk of adverse reactions.

IV Infusion:

Further Dilution: If administering droperidol via IV infusion, it should be further diluted before administration. This helps to ensure proper dosing and minimize the risk of complications associated with rapid infusion.

Mechanism of action of Droperidol:

Droperidol is a type of antipsychotic medication belonging to the butyrophenone class.
Its antiemetic effect works by blocking dopamine stimulation in the chemoreceptor trigger zone, helping to prevent nausea and vomiting.
Additionally, droperidol can cause alpha-adrenergic blockade, leading to peripheral vascular dilation and reducing the pressor effect of epinephrine, which can result in lowered blood pressure and decreased peripheral vascular resistance.
It may also reduce pulmonary artery pressure.

Onset of Action:

Droperidol typically starts to work within 3 to 10 minutes after administration.

Peak Effect:

The peak effect of droperidol is usually reached around 30 minutes after administration.

Duration:

The effects of droperidol typically last between 2 to 4 hours, but in some cases, they may persist for up to 12 hours.

Absorption:

When administered intramuscularly (IM), droperidol is absorbed rapidly into the bloodstream.

Distribution:

Droperidol crosses the blood-brain barrier, allowing it to exert its effects on the central nervous system (CNS).
In children, the volume of distribution is approximately 0.6 liters per kilogram, while in adults, it's around 1.5 liters per kilogram.

Protein Binding:

Approximately 85% to 90% of droperidol in the bloodstream is bound to proteins.

Metabolism:

Droperidol undergoes hepatic metabolism, where it is broken down into metabolites such as p-fluorophenylacetic acid, benzimidazolone, and p-hydroxypiperidine.

Half-life Elimination:

In children, the half-life of droperidol is approximately 1.7 hours, while in adults, it's around 2 hours.

Excretion:

Droperidol and its metabolites are primarily excreted in the urine (approximately 75%, with less than 1% as unchanged drug) and feces (approximately 22%, with 11% as unchanged drug).

International Brand Names of Droperidol: