DROPERIDOL

DROPERIDOL
(droe-per'i-dole)
Inapsine
Classifications: butyrophenone; antiemetic; anxiolytic;
Therapeutic: antiemetic; antianxiety

Prototype: Haloperidol
Pregnancy Category: C

Availability

2.5 mg/mL injection

Action

Butyrophenone derivative structurally and pharmacologically related to haloperidol. Antagonizes emetic effects of morphine-like analgesics and other drugs that act on chemoreceptor trigger zone.

Therapeutic Effect

Sedative property reduces anxiety and motor activity without necessarily inducing sleep; patient remains responsive. Has antiemetic properties, and potentiates other CNS depressants.

Uses

To produce tranquilizing effect and to reduce nausea and vomiting during surgical and diagnostic procedures. Also for premedication, during induction, and as adjunct in maintenance of general or regional anesthesia. Principally used in fixed combination with the potent narcotic analgesic fentanyl (Innovar) to produce neuroleptanalgesia (quiescence, reduced motor activity, and indifference to pain and environmental stimuli) to permit carrying out a variety of diagnostic and minor surgical procedures.

Unlabeled Uses

IV antiemetic in cancer chemotherapy.

Contraindications

Known or suspected QT elongation; history of torsades de pointes; known intolerance to droperidol; hypokalemia, hypomagnesia, pregnancy (category C), lactation. Safe use in children <2 y is not established.

Cautious Use

Older adult, debilitated, alcoholism, and other poor-risk patients; MAOI therapy; Parkinson's disease; cardiac disease; cardiac bradyarrhythmias, cardiac arrhythmias, CHF, hypotension; liver and kidney impairment or disease.

Route & Dosage

Postoperative Nausea and Vomiting Prevention Using Continual ECG Monitoring
Adult: IV/IM 2.5 mg; additional doses of 1.25 mg may be given
Child: IV/IM 0.1 mg/kg (max: 2.5 mg)

Renal Impairment
Due to increased risk of QT prolongation and torsades de points continuous monitoring is required.

Administration

Intramuscular
  • Give deep IM into a large muscle.
Intravenous
  • IV administration to infants and children: Verify correct rate of IV injection with physician.

PREPARE: Direct: Give undiluted.  

ADMINISTER: Direct: Give at a rate of 10 mg or fraction thereof over 30–60 sec.  

INCOMPATIBILITIES Solution/additive: barbiturates. Y-site: Allopurinol, amphotericin B cholesteryl complex, cefepime, cefotetan, fluorouracil, foscarnet, furosemide, heparin, leucovorin, methotrexate, nafcillin, piperacillin/tazobactam.

  • Store at 15°–30° C (59°–86° F), unless otherwise directed by manufacturer. Protect from light.

Adverse Effects (≥1%)

CNS: Postoperative drowsiness, extrapyramidal symptoms: dystonia, akathisia, oculogyric crisis; dizziness, restlessness, anxiety, hallucinations, mental depression. CV: Hypotension, tachycardia, irregular heartbeats (prolonged QTc interval even at low doses). Other: Chills, shivering, laryngospasm, bronchospasm.

Interactions

Drugs: Additive effect with CNS depressants, metoclopramide may increase extrapyramidal symptoms, closely monitor other drugs affecting QT interval.

Pharmacokinetics

Onset: 3–10 min. Peak: 30 min. Duration: 2–4 h; may persist up to 12 h. Distribution: Crosses placenta. Metabolism: In liver. Elimination: In urine and feces.

Nursing Implications

Assessment & Drug Effects

  • Monitor ECG throughout therapy. Report immediately prolongation of QTc interval.
  • Monitor vital signs closely. Hypotension and tachycardia are common adverse effects.
  • Exercise care in moving medicated patients because of possibility of severe orthostatic hypotension. Avoid abrupt changes in position.
  • Observe patients for signs of impending respiratory depression carefully when receiving a concurrent narcotic analgesic.
  • Note: EEG patterns are slow to return to normal during the postoperative period.
  • Observe carefully and report promptly to physician early signs of acute dystonia: Facial grimacing, restlessness, tremors, torticollis, oculogyric crisis. Extrapyramidal symptoms may occur within 24–48 h postoperatively.
  • Note: Droperidol may aggravate symptoms of acute depression.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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