Intramuscular, Intravenous Postoperative nausea and vomiting
Adult: Prevention and treatment: 0.625-1.25 mg via slow IV inj given 30 minutes prior to the anticipated end of surgery. Doses may be repeated 6 hourly as necessary. Alternatively, may administer a Max initial dose of 2.5 mg via slow IV inj or IM inj; additional 1.25 mg doses may be given to reach the desired effect. Doses must be individualised based on age, body weight, underlying condition, concomitant drugs used, type of anaesthesia used, and surgical procedure. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product or local guidelines). Elderly: Prevention and treatment: 0.625 mg via slow IV inj given 30 minutes prior to the anticipated end of surgery. Doses may be repeated 6 hourly as necessary. Child: Prevention and treatment: >2 years 0.02-0.05 mg/kg (Max: 1.25 mg/dose) via slow IV inj given 30 minutes prior to the anticipated end of surgery. Doses may be repeated 6 hourly as necessary. Doses must be individualised based on age, body weight, underlying condition, concomitant drugs used, type of anaesthesia used, and surgical procedure. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product or local guidelines).
Intravenous Prophylaxis of nausea and vomiting associated with postoperative patient controlled analgesia (PCA)
Adult: For cases induced by morphine and derivatives: 0.015-0.05 mg of droperidol per 1 mg of morphine. Max: 5 mg daily. Treatment recommendations may vary among individual products and between countries (refer to specific product or local guidelines).
Renal Impairment
Postoperative nausea and vomiting:
0.625 mg via slow IV inj given 30 minutes prior to the anticipated end of surgery. Doses may be repeated 6 hourly as necessary.
Hepatic Impairment
Postoperative nausea and vomiting:
0.625 mg via slow IV inj given 30 minutes prior to the anticipated end of surgery. Doses may be repeated 6 hourly as necessary.
Contraindications
Known or suspected QT interval prolongation (defined as prolonged QTc >440 milliseconds in males and >450 milliseconds in females), including known or history of congenital long QT syndrome; bradycardia (<55 bpm), known concurrent treatment that may lead to bradycardia; hypokalaemia, hypomagnesaemia, comatose states, phaeochromocytoma; severe depression, Parkinson's disease. Concomitant use with other neuroleptics, metoclopramide, and agents known to prolong QT interval (e.g. class IA and III antiarrhythmics, macrolides, fluoroquinolones, certain antihistamines, certain antipsychotics, antimalarials, cisapride, domperidone, methadone, pentamidine).
Special Precautions
Patient with risk factors for arrhythmia (e.g. history of serious ventricular arrhythmia, 2nd- or 3rd-degree AV block, sinus node dysfunction, CHF, ischaemic heart disease, left ventricular hypertrophy, significant COPD and respiratory failure); decreased gastrointestinal motility, benign prostatic hyperplasia, urinary retention, visual problems, xerostomia; risk factors for aspiration pneumonia (e.g. Alzheimer's disease); epilepsy or conditions predisposing to epilepsy (e.g. history of seizures, alcohol use disorder, brain damage, head trauma). Patients with dehydration, strenuous exercise, and heat exposure. Droperidol must be reserved for use in patients who fail to show acceptable response to other adequate therapies, either due to insufficient effectiveness or inability to achieve an effective dose because of intolerable adverse effects (consult local guidelines). Concomitant use with agents that may induce electrolyte imbalance (e.g. diuretics, laxatives, glucocorticoids). Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Hypotension, reflex tachycardia, VTE; oesophageal dysmotility and aspiration; anticholinergic effects (e.g. blurred vision, xerostomia, constipation, urinary retention); CNS depression, extrapyramidal syndrome (e.g. pseudoparkinsonism, akathisia, tardive dyskinesia, acute dystonic reactions); risk of falls due to somnolence or orthostatic hypotension; impaired core body temperature regulation, hyperprolactinaemia; severe hypertension and tachycardia (particularly in patients with known or suspected phaeochromocytoma). Rarely, neuroleptic malignant syndrome. Nervous system disorders: Dizziness, drowsiness. Psychiatric disorders: Anxiety, restlessness, hallucination. Respiratory, thoracic and mediastinal disorders: Bronchospasm, laryngospasm. Vascular disorders: Syncope. Potentially Fatal: QT interval prolongation, torsades de pointes, ventricular arrhythmias, cardiac arrest.
Perform a 12-lead ECG before administration to check for QT interval prolongation; in patients whom the potential benefit of droperidol outweighs the risk of serious arrhythmias, perform ECG monitoring prior to administration and continue for 2-3 hours following treatment completion. Monitor vital signs, cardiac and respiratory status, mental status and alertness, serum electrolytes (e.g. potassium, magnesium), renal function, and liver function. Assess for extrapyramidal symptoms for 24-48 hours following therapy and signs of orthostatic hypotension.
Overdosage
Symptoms: Psychic indifference with a transition to sleep which may be associated with lowered blood pressure; extrapyramidal effects (e.g. salivation, abnormal movements, muscle rigidity), convulsions, QT prolongation, and serious arrhythmias (e.g. torsades de pointes). Management: Supportive and symptomatic treatment. If hypoventilation or apnoea occurs, provide adequate oxygenation and assist or control respiration. Maintain a patent airway; oropharyngeal or endotracheal tube may be indicated. In case of severe or persistent hypotension, consider the possibility of hypovolaemia and give appropriate parenteral fluid therapy. Administer anticholinergics for significant extrapyramidal reactions. Maintain body warmth and adequate fluid intake. Closely monitor the patient for 24 hours or longer.
Drug Interactions
May increase the risk of electrolyte imbalance with diuretics, laxatives, and glucocorticoids. May cause additive or potentiating effects with other CNS depressants (e.g. opioids, tranquilisers, barbiturates, general anaesthetics). May inhibit the activity of dopamine agonists (e.g. levodopa, bromocriptine, lisuride). May reduce the rate of metabolism and prolong the pharmacological effect with CYP1A2 inhibitors (e.g. ciprofloxacin, ticlopidine) and CYP3A4 inhibitors (e.g. ketoconazole, nefazodone, ritonavir, verapamil). Potentially Fatal: Increased risk of QT interval prolongation and torsades de pointes with agents known to prolong QT interval, such as class IA antiarrhythmics (e.g. quinidine, disopyramide), class III antiarrhythmics (e.g. amiodarone, sotalol), macrolides (e.g. erythromycin), antipsychotics (e.g. chlorpromazine, haloperidol, pimozide, thioridazine), fluoroquinolones (e.g. sparfloxacin), certain antihistamines (e.g. astemizole, terfenadine), antimalarial agents (e.g. chloroquine, halofantrine), cisapride, domperidone, pentamidine, and methadone. May increase the incidence of extrapyramidal symptoms with metoclopramide and other neuroleptics.
Food Interaction
May cause additive CNS depressant effects with alcohol.
Action
Description: Mechanism of Action: Droperidol is a butyrophenone neuroleptic agent that has similar properties to haloperidol. It produces an antiemetic effect by inhibiting the dopamine receptors in the chemoreceptor trigger zone in the area postrema. It also exhibits α-adrenergic blockade, peripheral vasodilation, and reduction of epinephrine pressor effect leading to hypotension and decreased peripheral resistance. Pulmonary artery pressure may also be reduced. Onset: IM/IV: 3-10 minutes. Pharmacokinetics: Distribution: Crosses the blood-brain barrier. Volume of distribution: Approx 1.5 L/kg. Plasma protein binding: 85-90%. Metabolism: Extensively metabolised in the liver mainly by CYP1A2 and CYP3A4, and to a lesser extent by CYP2C19 isoenzyme to form p-fluorophenylacetic acid, benzimidazole, and p-hydroxypiperidine. Excretion: Via urine (75%; <1% as unchanged drug); faeces (22%; 11% as unchanged drug). Elimination half-life: Approx 2 hours.
Chemical Structure
Droperidol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3168, Droperidol. https://pubchem.ncbi.nlm.nih.gov/compound/Droperidol. Accessed May 29, 2024.
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