Droperidol . dosing

A recent report indicated that droperidol (mean dose 0.44 0.22 cc [0.44 0.22 mg]) was effective in 26 aggressive children with externalizing disorders. All children receiving droperidol were able to return to the milieu 2 hours later (Joshi et ah, 1998). 

The fixed dose combination of fentanyl (0.05 mg) and droperidol (2.5 mg/ml), 4 to 6 ml is diluted in glucose solution and infused IV over 10 minutes. 

Intravenous administration of low-dose, high-potency agents is also an option in certain clinical situations. For example, i.v. haloperidol, alone or in combination with i.v. lorazepam, has been safe and effective in managing delirium in critically ill, medical patients ( 152, 153). At times, effective doses of haloperidol may be as low as 0.5 to 1 mg when given by this route. Alternatively, droperidol may offer some advantages over haloperidol, including overall efficacy, safety, and rapidity of onset (.154). 

Although mania in AIDS patients appears to be uncommon, such episodes can pose a serious hazard and require rapid control. Intravenous haloperidol or droperidol may be effective strategies, in part because this route of administration may be less likely than oral doses to induce acute extrapyramidal side effects ( 489, 490). Some concern, however, has been raised with the potential prolongation of the QT interval with droperidol, requiring caution in this regard. 

The most notable differences from thiopentone consist of a high incidence of spontaneous muscle movements, tremor and hypertonus (20% compared with 4% for thiopentone). The incidence is directly related to the dose and rate of administration and is increased by drugs, such as hyoscine and droperidol, and decreased by opioid premedication. Respiratory complications. 

Domperidone is structurally related to droperidol. It does not cross the blood-brain barrier to the same extent as droperidol so has fewer sedative side effects. It has an effect both on the CTZ and by a peripheral action on the stomach by increasing gastric emptying. Timing of the dose of drug is important for maximal efficacy. 

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

Droperidol 5-7.5 mg given during induction of anesthesia was associated with impaired well-being scores 6 hours postoperatively in a randomized double-blind comparison of similar doses of droperidol (n = 78) and midazolam (n = 72) for preventing postoperative nausea and vomiting (2). 

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. 

In a randomized, double-blind, dose-ranging study in 305 adults receiving droperidol 0.1, 2.75, 5.5, and 8.25 mg for the acute treatment of migraine, the number of patients who achieved a pain-free response at 2 hours after treatment was significantly greater than with placebo for droperidol 2.75, 5.5, and 8.25 mg (8). The most frequent adverse events were akathisia and weakness, and adverse events were dose related. Anorexia, anxiety, somnolence, tremor, and confusion were also reported. No patient had QT interval prolongation. 

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). 

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). 

Droperidol 0.5 micrograms reduced the need for postoperative morphine delivered via a patient-controlled analgesia device (31). At these doses it was non-sedating and caused no dyskinetic movements. 

Animal studies suggest that large doses of pethidine and droperidol can augment the myoneural effects of neuromuscular blocking agents (32). 

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