Droperidol adverse effects

Prophylactic intravenous droperidol (10, 20, 40, or 80 micrograms/kg) dose-dependently reduced postoperative nausea and vomiting without increasing the time to discharge in 82 children who underwent strabismus surgery (5). There were no particular adverse effects, but sedation scores were higher in those who received the higher doses. 

Intramuscular droperidol 2.5 mg was used to treat 23 consecutive patients with acute migraine who had not responded to other drugs (20). If no relief was achieved by 30-60 minutes after treatment, and no significant adverse effects were reported, a second dose of droperidol 2.5 mg was given. Varying degrees of akathisia after treatment were reported by six patients. Similarly, in a retrospective series of 37 patients who received droperidol 2.5 mg for migraine, 3 developed mild akathisia and 5 had drowsiness (21). 

Intravenous ondansetron (4 mg at induction of anesthesia and 0.13 mg with each 1 mg bolus of morphine) has been compared with intravenous droperidol (0.5 mg at induction and 0.05 mg with each bolus of morphine) in a double-blind trial in 142 patients (22). The two regimens had similar efficacy in the prevention of postoperative nausea and vomiting. The most important adverse effect was sedation significantly more patients given droperidol (15%) had excessive sedation than patients given ondansetron (5%). 

Intravenous lidocaine has been used to treat severe chronic daily headache in 19 patients (three men, median age 37 years) (9). There were adverse effects during four infusions of lidocaine hyperkalemia (6.4 mmol/1), which did not resolve after withdrawal of lidocaine transient hypotension (75/50 mmHg), which was attributed to concomitant droperidol an unspecified abnormality of cardiac rhythm and on another occasion a transient bradycardia and chest pain with a normal electrocardiogram, fever, and intractable nausea. The study was neither randomized nor placebo-controlled, and in no case was the adverse event strongly associated with the administration of lidocaine. 

Nausea and vomiting are frequent adverse effects associated with the use of PCA opioids. Droperidol and tro-pisetron may reduce the incidence and severity of nausea and vomiting caused by morphine (SEDA-19, 84). 

A prospective, randomized, double-blind study of 97 women investigated whether droperidol alleviated the adverse effects of epidural morphine after cesarean section (54). All groups received morphine 5 mg epiduraUy on delivery, accompanied by no droperidol, or droperidol 2.5 mg epiduraUy, or droperidol 2.5 mg intravenously. Pruritus occurred in 70% of patients, starting at 6 hours... 

Adverse reactions Well tolerated with few side effects. Headache, especially at higher doses, is the most common adverse effect. Others include dizziness, fatigue, constipation, Gl upset, and elevations in hepatic transaminases. Metoclopramide and prochlorperazine may cause dystonic reactions or EPS at high doses. High doses of droperidol may cause QT(- prolongation. Others include sedation, dizziness, and dry mouth. 

Metoclopramide increases the rate of gastric emptying so that the rate of morphine absorption from the small intestine is increased. An alternative idea is that both drugs act additively on opiate receptors to increase sedation. Droperidol may also enhance adverse effects such as sedation, and in some cases respiratory depression, possibly through opioid and other receptor sites in the CNS. In one case the respiratory depression was not reversed by naloxone, suggesting that the droperidol was at least partially if not completely responsible. ... 

Although used extensively for the past several decades, droperidol and metoclopramide are less commonly used today because of their potential severe adverse effects, the black-box warning from the FDA for both drugs, and the comparable price of the generic ondansetron. Possible prolongation of the QT interval leading to torsade de pointes following droperidol use and tardive dyskinesia associated with metoclopramide use limit their use. However, there is little... 

Nervous System A systematic review of low-dose use of droperidol as an antiemetic from 25 trials (2957 patients) reported extrapyramidal side effects, increased restlessness and decreased headache [143 ]. A study of use in 144 children at doses of 10 ng/kg reported sedation as the only side effect in 27% [144 ]. The use of low-dose droperidol for the treatment of headaches in the emergency room in 73 patients was associated with two cases of extrapyramidal reaction (restlessness/anxiousness and dystonia) [145 ]. Three of 589 patients experienced extrapyramidal reactions with droperidol infusion for nausea and vomiting [146 ]. Adverse effects occurring in 49 elderly patients treated with droperidol for agitation include hypotension (2), oversedation (2) and hypotension/oversedation (1) [147 ]. A case of an extrapyramidal reaction ataxia/dyskinesia) is reported in a female undergoing laparoscopic cholecystectomy [148 ]. 

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