👋👋 A quick poll to start off this week's TIL
[❔]: Does your institution have droperidol on formulary?
1/
#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
Droperidol ➡️ butyrophenone, D2 receptor antagonist, similar to haloperidol with
✅ faster onset (3-10m IV/IM)
✅ shorter-acting
✅ more sedating
Dosing = 0.625 - 10 mg
Indications: Agitation, N/V, HA/migraine, vertigo, adjunct analgesic
ADEs = EPS, hypoTN, QTp
Preg = C
2/
[1961]: Developed
[1960s - 2000]: Frequently used in ED
[2001]: FDA ⬛️ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of 💉 products ⏩ ultimately withdrawn from market 🪦
[2019]: American Regent™️ announces droperidol is back 👀... so is it worth the risk?
3/
@FOAMpodcast (@LWestafer, @jeremyfaust) did an amazing podcast on the FDA ⬛️ warning & the evidence behind it. Here's the facts
🔍n=277; Duplicates, reporting error ➡️ really only 67 individual cases
🔍 Doses up to 600mg🤯
🔍 Majority of cases had confounding factors
4/
Habib et al [PMID: 12707137] conducted an analysis of the 10 cases w/ droperidol 2.5mg or less associated w/ the FDA ⬛️
In 2013, AAEM published a statement on what they thought about the FDA ⬛️ on droperidol
[LINK] aaem.org/UserFiles/file…
5/
What about safety/efficacy❓
DORM Study RCT (n=223) [PMID:20868907]
✅ Droperidol 10mg IM comparable to midazolam 10mg IM
DORM 2 (n=1,403) [PMID:25890395]
✅ Droperidol 10mg IM for agitation
✅ Prolonged QT (1.3%), (0.6%) potentially attributable to droperidol and 0⃣TdP
6/
...and more
Taylor et al (n=349) [PMID: 27745766]
✅ Midazolam 5mg + droperidol 5mg > droperidol 10mg or olanzapine 10mg alone
✅ No difference in ADEs,0⃣cardiac ADEs
Gaw et al (n=1,674) [PMID: 31831345]
✅ No clinically sig arrhythmias or deaths attributed to droperidol
7/
Gottlieb et al (n=733) [PMID: 28662911]
✅ No difference vs Haldol, Zyprexa, or Versed
✅ Less rescue doses vs Haldol @ 60min
✅ No difference in cardiac dysrhythmias
🔥Just published🔥
Cole et al (2020) [PMID: 32726229]
✅ Incidence of TdP 0.006% (1/16,546)
8/
Bottom line:
🅰️ The risk of clinically significant QTp or TdP appears to be overstated
🅱️ Droperidol up to 10mg IV/IM has at least a similar safety & efficacious profile as other Rx used commonly in the ED for acute agitation
☑️ Lots of evidence supporting 🆎
The end
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