Evidence‑based review and appraisal of the use of droperidol in the emergency department

Pei‑Chun Lai^{a, b}, Yen‑Ta Huang^{c, d*}

^aDepartment of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien, Taiwan, ^bSchool of Medicine, Tzu Chi University, Hualien, Taiwan, ^cDivision of Experimental Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, Hualien, Taiwan, ^dDepartment of Pharmacology, Tzu Chi University, Hualien, Taiwan

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Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation

Abstract

Droperidol is a short‑acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low‑dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence‑based analysis to appraise high‑quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED). Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision‑making.

Keywords: Acute psychosis, Droperidol, Migraine, Nausea/Vomiting, QT prolongationemergency