droperidol: clinical use

Prescribing considerations

• Assess cardiac history, previous syncope, family history of congenital QT prolongation and concurrent QT-prolonging medicines.
• Check for bradycardia and correct hypokalaemia or hypomagnesaemia before use.
• Use particular caution with epilepsy, hepatic or renal impairment, older age, CNS depressants and medicines causing electrolyte loss.
• Consider additive sedation, respiratory depression and hypotension with perioperative medicines.

Contraindications and cautions

• Hypersensitivity to droperidol, an excipient or another butyrophenone
• Known or suspected QT prolongation, congenital long-QT syndrome or relevant family history
• Concomitant medicines known to cause torsades de pointes through QT prolongation
• Hypokalaemia or hypomagnesaemia
• Marked bradycardia or concurrent treatment known to cause bradycardia
• Phaeochromocytoma, coma, Parkinson’s disease or severe depression

Monitoring

• Review QTc, heart rate, electrolytes and interacting medicines in patients with relevant risk factors.
• Monitor blood pressure, consciousness, respiration and extrapyramidal effects after administration.
• Use continuous pulse oximetry when ventricular-arrhythmia risk is identified or suspected, as specified in the product information.

Clinical pharmacology

Droperidol is a butyrophenone with potent dopamine D2-receptor antagonism. After intravenous administration it acts rapidly, is highly protein-bound and undergoes extensive hepatic metabolism, mainly through CYP1A2 and CYP3A4; its metabolites lack neuroleptic activity.

Formulation and product differences

• The selected product is a clear, colourless intravenous solution supplied in single-use amber-glass ampoules and protected from light.
• It is essentially sodium-free and incompatible with barbiturates.
• After opening it is intended for immediate use; compatibility and handling requirements apply if prepared with morphine for patient-controlled analgesia.

Injection

Route: Parenteral

Strengths: 2.5 mg/mL