BLACK BOX WARNING
- QT prolongation and fatal cardiac arrhythmias (torsades de pointes) reported even at low doses; baseline ECG required; continuous cardiac monitoring required post-administration
droperidol
Brand: Inapsine
⚠ BBW ISMP High Alert Beers Criteria
Drug Class: butyrophenone / dopamine antagonist
Drug Family: antiemetic
Subclass: butyrophenone antipsychotic / antiemetic
Organ Systems: gastrointestinalcns
Mechanism of Action
Potent D2 dopamine receptor antagonist in the chemoreceptor trigger zone, blocking dopamine-mediated emetic signaling. Also blocks alpha-1 adrenergic receptors, contributing to hypotension. At low doses, useful as an antiemetic; at higher doses, produces neuroleptic sedation.
D2 dopamine receptors (CTZ)alpha-1 adrenergic receptors
Indications
- PONV (prevention and treatment)
- nausea and vomiting (adjunct)
- agitation in emergency settings (off-label)
Contraindications
- known or suspected QT prolongation (QTc >440 ms men, >450 ms women)
- hypokalemia
- hypomagnesemia
- concomitant class I or III antiarrhythmics
Adverse Effects
Common
- sedation
- hypotension
- extrapyramidal symptoms
- anxiety/restlessness (akathisia)
Serious
- QT prolongation and torsades de pointes
- neuroleptic malignant syndrome
Pharmacokinetics (ADME)
| Absorption | IV and IM administration; rapid onset |
| Distribution | widely distributed; crosses BBB |
| Metabolism | hepatic via oxidative metabolism |
| Excretion | renal and fecal |
| Half-life | 2.2 hours |
| Onset | 3–10 minutes |
| Peak | 30 minutes |
| Duration | 2–4 hours |
| Protein Binding | 85–90% |
| Vd | 1.5 L/kg |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| QT-prolonging agents | additive QT prolongation; contraindicated combination | major |
| CNS depressants | additive sedation and respiratory depression | major |
| antihypertensives | additive hypotension | moderate |
Nursing Considerations
- Obtain baseline ECG before administration; assess for QTc prolongation, hypokalemia, and hypomagnesemia.
- Monitor cardiac rhythm continuously for 2–3 hours post-administration for QT changes and torsades de pointes.
- Assess blood pressure frequently; orthostatic hypotension is common due to alpha-1 blockade.
- Watch for extrapyramidal symptoms including akathisia, restlessness, and dystonia; diphenhydramine or benztropine may be used for treatment.
Clinical Pearls
- Despite the black box warning, droperidol at low antiemetic doses (0.625–1.25 mg) has a favorable PONV benefit-risk profile and remains widely used in anesthesia.
- Many anesthesiologists consider droperidol the most effective single agent for PONV prophylaxis, but the mandatory ECG and monitoring requirements have reduced its use in some settings.
Safety Profile
Pregnancy use-with-caution
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.