Droperidol antiemetic effects

In a randomized, placebo-controlled trial inl40 patients a combination of metoclopramide 10 mg and droperidol 1.25 mg or two doses of droperidol provided a more effective antiemetic effect than metoclopramide alone (9). The level of sedation was significantly greater in the patients who received two doses of droperidol (8/35) and metoclopramide followed by droperidol (7/35) than in those who received only placebo (0/35) or metoclopramide followed by placebo (0/35). 

Haloperidol was introduced for the treatment of psychoses in Europe in 1958 and in the United States in 1967 (Fig. 22.7). it is an effective aiternative to more famiiiar antipsychotic phenothiazine drugs and also is used for the manic phase of bipolar (manic-depressive) disorder. Haloperidol decanoate has been introduced as depot maintenance therapy. When injected every 4 to 6 weeks, the drug appears to be as effective as daily orally administered haloperidol. Other currently available (mostly in Europe) butyrophenones include the very potent spiperone (spiroperidol) as well as trifluperidol and droperidol. Droperidol, a short-acting, sedating butyrophenone, is used in anesthesia for its sedating and antiemetic effects and, sometimes, in psychiatric emergencies as a sedative-neuroleptic. Droperidol often is administered in combination with the potent narcotic analgesic fentanyl for preanesthetic sedation and anesthesia. 

Droperidol. Usual adult dose for delirium Is 5 mg IM and sedative dose Is 2.5-5.0 mg IM. For antiemetic effects, usually given 30-60 minutes as a premedioation, 2.5-10 mg (children 0.088-0.165 mg/kg) IV or IM. Note See warnings above use alternate antiemetics as first-line therapy. 

Combinations of antiemetics may be the most effective method of preventing PONV for high-risk patients.7,42 Droperidol plus a 5-HT3 antagonist or dexamethasone plus a 5-HT3 antagonist are effective combinations.43,44 Three-drug combinations such as dexamethasone, droperidol, and a 5-HT3 antagonist have not been formally studied but may be a reasonable approach.42... 

Butyrophenones Haloperidol, droperidol and domperidone act by blocking dopamine receptors. The butyrophenones are moderately effective antiemetics, but high-dose haloperidol was found to... 

Dexamethasone is an effective prophylactic agent when administered either alone or in combination with other antiemetic drugs before the induction of anesthesia." Droperidol has been one of the most effective agents for PONV prophylaxis. At a dose of 1.25 mg IV, it was more effective and much less costly than combination therapy with ondansetron 4 mg TV and droperidol 0.625 mg TV." As discussed earlier, the recent FDA black box warning has effectively removed droperidol from clinical use. As a result of conflicting data. 

Hill RP, Lubarsky DA, Phillips-Bute B, et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol or placebo. Anesthesiology 2000 92 958-967. 

Droperidol is used as an adjunct for induction and maintenance of general anesthesia and as an anesthetic in diagnostic procedures. Droperidol, which has antiemetic properties, causes marked sedation and potentiates the CNS depressant effects of alcohol, hypnotic-sedatives, and numerous psychoactive agents. Droperidol is absorbed well through an IM injection—sedation begins in 3 minutes, peaks at 30 minutes, and lasts for 2 to 4 hours. Droperidol is metabolized by the liver to p-fluoro-phenylacetic acid and p-hydroxypiperidine, and its metabolites are excreted in urine and feces. 

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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