droperidol


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droperidol

 [dro-per´ĭ-dol]
a drug of the butyrophenone series, used for its antianxiety, sedative, and antiemetic effects as a premedication prior to surgery and during induction and maintenance of anesthesia, as a postanesthesia antiemetic, and to produce conscious sedation; administered intravenously or intramuscularly. A combination of droperidol and fentanyl citrate is administered intramuscularly to produce neuroleptanalgesia.

droperidol

Inapsine

Pharmacologic class: Butyrophenone

Therapeutic class: General anesthetic, antiemetic

Pregnancy risk category C

FDA Box Warning

• QT prolongation and torsades de pointes may occur at or below recommended doses, even in patients with no known risk factors. (Risk factors for prolonged QT syndrome include heart failure, bradycardia, cardiac hypertrophy, hypokalemia, hypomagnesemia, age older than 65, alcohol abuse, and use of diuretics, drugs that prolong the QT interval, benzodiazepines, volatile anesthetics, or I.V. opioids.) Some cases have been fatal. Reserve drug for patients with refractory disease. Use with extreme caution in patients at risk for prolonged QT interval.

• Drug is contraindicated in patients with known or suspected QT prolongation.

Action

Produces marked sedation by directly blocking subcortical receptors. Produces antiemetic effect by blocking CNS receptors in chemoreceptor trigger zone.

Availability

Injection: 2.5 mg/ml in 1-ml, 2-ml, and 5-ml ampules and in 2-ml, 5-ml, and 10-ml vials

Indications and dosages

Perioperative nausea and vomiting

Adults: Initially, 2.5 mg I.M. or I.V. Additional doses of 1.25 mg may be given. Dosages are highly individualized according to patient's age, weight, physical status, and underlying pathologic condition.

Children ages 2 to 12: Initially, 0.1 mg/kg I.M. or I.V. Additional doses up to a total of 2.5 mg may be given. Dosages are highly individualized according to patient's age, weight, physical status, and underlying clinical condition.

Dosage adjustment

• Elderly or debilitated patients

• High-risk patients (such as patients over age 65 and those with heart failure, alcohol abuse, or other factors that predispose to prolonged QT interval)

• Patients who have received other CNS depressants (such as analgesics or anesthetics)

Contraindications

• Hypersensitivity to drug

• Known or suspected QT-interval prolongation (more than 440 millisec in males or 450 millisec in females)

Precautions

Use cautiously in:

• severe cardiac or renal disease, diabetes mellitus, respiratory insufficiency, prostatic hypertrophy, angle-closure glaucoma, CNS depression, CNS tumors, intestinal obstruction, bone marrow depression

• elderly patients

• pregnant or breastfeeding patients

• children younger than age 2.

Administration

• Know that drug is indicated to ease perioperative nausea and vomiting only in patients who don't respond adequately to other treatment.

• Be aware that drug doesn't need to be diluted for I.V. or I.M. use.

• Give by slow I.V. injection, or inject I.M. into large muscle.

Adverse reactions

CNS: weakness, dysarthria, dysphonia, dizziness, extrapyramidal reactions, headache, postoperative hallucinatory episodes with transient depression, tremor, irritability, paresthesia, aggression, vertigo, ataxia, loss of consciousness, seizures, neuroleptic malignant syndrome

CV: chest pain, hypertension, hypotension, vasodilation, arrhythmias, atrial fibrillation

EENT: cataracts, blurred vision, eye irritation, sore throat

GI: nausea, vomiting, diarrhea, abdominal cramps, bloating, epigastric pain, fecal incontinence, increased salivation, dysphagia

GU: urinary frequency, increased libido

Hepatic: cholestatic jaundice

Metabolic: dehydration

Musculoskeletal: muscle cramps, arthritis, bone fractures

Respiratory: bronchitis, dyspnea

Skin: bruising, rash, urticaria, facial sweating, diaphoresis, pruritus, flushing

Other: toothache, weight loss, hot flashes, influenza, chills

Interactions

Drug-drug. Antihypertensives, nitrates: additive hypertension

CNS depressants (including antidepressants, antihistamines, opioids): additive CNS depression

Drugs that induce hypokalemia or hypomagnesemia (such as diuretics and laxatives and supraphysiologic use of steroid hormones with mineralocorticoid activity): possible precipitation, QT interval prolongation

Drugs that prolong QTc interval (such as antidepressants, class I or III antiarrhythmics, antimalarials, calcium channel blockers, some antihistamines, some neuroleptics): increased risk of conduction abnormalities

Drug-herbs. Chamomile, hops, kava, skullcap, valerian: increased CNS depression

Drug-behaviors. Alcohol use: additive CNS depression

Patient monitoring

Monitor QT interval; report prolongation. Also watch for torsades de pointes.

Know that drug may cause sudden death at high doses (above 25 mg) in patients at risk for arrhythmias.

Monitor for signs and symptoms of neuroleptic malignant syndrome, such as hyperthermia, severe extrapyramidal symptoms, altered mental status, stupor, coma, hypertension, tachycardia, pallor, or diaphoresis. (However, this syndrome is rare.)

• Assess vital signs frequently. Stay alert for orthostatic hypotension and tachycardia. Keep I.V. fluids and vasopressors on hand to treat pronounced hypotension.

Don't place hypotensive patient in Trendelenburg position because this may deepen anesthesia, precipitating respiratory arrest.

• Avoid abrupt position changes.

• Observe for signs and symptoms of respiratory compromise if drug is used concurrently with narcotics.

Patient teaching

• Advise patient not to drink alcohol or take CNS depressants for 24 hours after receiving drug.

• Tell patient drug may cause extreme drowsiness for several days after administration.

• Caution patient not to drive or perform other activities requiring mental alertness.

• Instruct patient to change positions slowly.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

droperidol

A butyrophenone antipsychotic drug that causes emotional quietening and a state of mental detachment. It is sometimes used as a premedication before surgery.
References in periodicals archive ?
In a small study we conducted, 49 women with hyperemesis gravidarum received droperidol 1 mg/hr for 37 hours.
The most severe form of nausea, hyperemesis gravidarum, occurs in less than 1% of pregnancies and requires hospitalization and intravenous antiemetics, such as droperidol (Inapsine), prochlorperazine, and ondansetron.
In the article on droperidol and acutely agitated patients, Dr.
Hyperemesis gravidarum, requires intravenous antiemetics, such as droperidol (Inapsine), prochlorperazine, and ondansetron.
(12) Table The safety of selected drugs in patients susceptible to malignant hyperthermia Do not use (trigger agents) Cyclopropane Depolarizing muscle relaxants (e.g., succinylcholine) d-Tubocurarine Ether Methoxyflurane Rapid intravenous potassium Volatile inhalational anesthetics (desflurane, enflurane, halothane, isoflurane, sevoflurane) Use cautiously Catecholamines Haloperidol Phenothiazines (chlorpromazine, prochlorperazine) Safe to use Anticholinergics Anticholinesterases Barbiturates Benzodiazepines Calcium Droperidol Etomidate Ketamine Local anesthetics Narcotics Nitrous oxide Nondepolarizing muscle relaxants Nonsteroidal anti-inflammatory drugs Propofol
The week he died he was given the anti-psychotic drugs risperidone and droperidol - which has since been banned.
Another area of contention relates to an incident that occurred in Sully Hospital on July 5 2000, when Mr Millross claims he was forcibly injected with the drugs lorazepam and droperidol.
JR's immediate post-procedure course was remarkable only for nausea and vomiting, which was treated with droperidol, and persistent sleepiness.
Antiemetics included droperidol, ondansetron, and dexamethasone while ciprofloxacin was administered for surgical site prophylaxis due to a penicillin allergy.
The meta-analysis of the new CCTs ratifies that droperidol reduces postoperative nausea and vomiting and the use of rescue antiemetics (Evidence A3-B).
When providing pharmacotherapy for EDS, consider a benzodiazepine (midazolam, lorazepam, diazepam), an antipsychotic (haloperidol, droperidol, ziprasidone, olanzapine), or ketamine.4 Because these agents can have depressive respiratory and cardiovascular effects, continuously monitor heart and lungs.
All patients received antiemetic prophylaxis with dexamethasone, granisetron and/or droperidol using monotherapy in nine patients (22%), dual therapy in 30 patients (73%) and three agents in two patients (5%).