Droperidol

Aliases: Inapsine  

Indications: Agitation, Atraumatic Headache, Nausea/Vomiting, Vertigo, Acute exacerbation of chronic abdominal pain    

Contraindications: Hypersensitivity to drug, patients with signs of severe prolonged QTc   

Concentrations: 

Injection: 2.5 mg/mL

Dosing

Adult:

Indication	Dose	Route	Note
Agitation/Psychosis	10mg	IM	Give once. Trend RASS score every 5 minutes. Treat accordingly
Agitation/Psychosis	5mg	IV	Give once. Trend RASS score every 5 minutes. Treat accordingly
-Atraumatic Headache -Nausea/Vomiting -Dizziness/Vertigo -Acute exacerbation of chronic abdominal pain	2.5mg	IV/IM	May repeat once after 10 minutes.

Pediatric:

Indication	Dose	Route	Note
Agitation/Psychosis	0.1mg/kg Max: 10mg	IM	Give once. Trend RASS score every 5 minutes. Treat accordingly
Agitation/Psychosis	0.1mg/kg Max: 5mg	IV	Give once. Trend RASS score every 5 minutes. Treat accordingly
-Atraumatic Headache -Nausea/Vomiting -Dizziness/Vertigo -Acute exacerbation of chronic abdominal pain	0.1mg/kg Max: 2.5mg	IV/IM	Give once.

Precautions: ECG monitor must be applied as soon as possible when medication is given. 

Adverse/Side Effects: Neuroleptic malignant syndrome, sinus tachycardia, hypotension, akathisia, dystonic reaction, restlessness, drowsiness, anxiety  

Class: Butyrophenone neuroleptic.  

Mechanism of Action: Like haloperidol, droperidol antagonizes multiple receptor sites in the CNS including serotonin, GABA, norepinephrine, and especially, dopamine. There is evidence that butyrophenones antagonize dopamine-mediated neurotransmission at the synapse as well as block postsynaptic dopamine receptor sites. The antiemetic activity of droperidol is most likely due to blockade of dopamine receptors in the chemoreceptor trigger zone of the brain. It is associated with prolongation of the QTc interval and serious arrhythmias including torsade de pointes. Droperidol delays the recharging of potassium channels, thereby blocking the rapid component of the delayed rectifier potassium current, within minutes of a dose at the upper limit of the dosage range. 

Onset of Action	Peak Effect	Duration of Action
3-10 minutes	30 minutes	2-4 hours