ππ A quick poll to start off this week's TIL
[β]: Does your institution have droperidol on formulary?
1/
#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
[β]: Does your institution have droperidol on formulary?
1/
#TwitteRx #MedTwitter #FOAMed #emergencymedicine #NurseTwitter
Droperidol β‘οΈ butyrophenone, D2 receptor antagonist, similar to haloperidol with
β faster onset (3-10m IV/IM)
β shorter-acting
β more sedating
Dosing = 0.625 - 10 mg
Indications: Agitation, N/V, HA/migraine, vertigo, adjunct analgesic
ADEs = EPS, hypoTN, QTp
Preg = C
2/
β faster onset (3-10m IV/IM)
β shorter-acting
β 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[2001]: FDA β¬οΈ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of π products β© ultimately withdrawn from market πͺ¦
[2019]: American Regentβ’οΈ announces droperidol is back π... so is it worth the risk?
3/
[1960s - 2000]: Frequently used in ED
[2001]: FDA β¬οΈ Warning d/t QT prolongation & TdP + coincides w/ drug shortage of π products β© ultimately withdrawn from market πͺ¦
[2019]: American Regentβ’οΈ announces droperidol is back π... so is it worth the risk?
3/
@FOAMpodcast (@LWestafer, @jeremyfaust) did an amazing podcast on the FDA β¬οΈ warning & the evidence behind it. Here's the facts
πn=277; Duplicates, reporting error β‘οΈ really only 67 individual cases
π Doses up to 600mgπ€―
π Majority of cases had confounding factors
4/
πn=277; Duplicates, reporting error β‘οΈ really only 67 individual cases
π Doses up to 600mgπ€―
π 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 β¬οΈ
In 2013, AAEM published a statement on what they thought about the FDA β¬οΈ on droperidol
[LINK] aaem.org/UserFiles/fileβ¦
5/
In 2013, AAEM published a statement on what they thought about the FDA β¬οΈ on droperidol
[LINK] aaem.org/UserFiles/fileβ¦
5/
What about safety/efficacyβ
DORM Study RCT (n=223) [PMID:20868907]
β Droperidol 10mg IM comparable to midazolam 10mg IM
DORM 2 (n=1,403) [PMID:25890395]
β Droperidol 10mg IM for agitation
β Prolonged QT (1.3%), (0.6%) potentially attributable to droperidol and 0β£TdP
6/
DORM Study RCT (n=223) [PMID:20868907]
β Droperidol 10mg IM comparable to midazolam 10mg IM
DORM 2 (n=1,403) [PMID:25890395]
β Droperidol 10mg IM for agitation
β Prolonged QT (1.3%), (0.6%) potentially attributable to droperidol and 0β£TdP
6/
...and more
Taylor et al (n=349) [PMID: 27745766]
β Midazolam 5mg + droperidol 5mg > droperidol 10mg or olanzapine 10mg alone
β No difference in ADEs,0β£cardiac ADEs
Gaw et al (n=1,674) [PMID: 31831345]
β No clinically sig arrhythmias or deaths attributed to droperidol
7/
Taylor et al (n=349) [PMID: 27745766]
β Midazolam 5mg + droperidol 5mg > droperidol 10mg or olanzapine 10mg alone
β No difference in ADEs,0β£cardiac ADEs
Gaw et al (n=1,674) [PMID: 31831345]
β No clinically sig arrhythmias or deaths attributed to droperidol
7/
Gottlieb et al (n=733) [PMID: 28662911]
β No difference vs Haldol, Zyprexa, or Versed
β Less rescue doses vs Haldol @ 60min
β No difference in cardiac dysrhythmias
π₯Just publishedπ₯
Cole et al (2020) [PMID: 32726229]
β Incidence of TdP 0.006% (1/16,546)
8/
β No difference vs Haldol, Zyprexa, or Versed
β Less rescue doses vs Haldol @ 60min
β No difference in cardiac dysrhythmias
π₯Just publishedπ₯
Cole et al (2020) [PMID: 32726229]
β Incidence of TdP 0.006% (1/16,546)
8/
Bottom line:
π °οΈ The risk of clinically significant QTp or TdP appears to be overstated
π ±οΈ 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
βοΈ Lots of evidence supporting π
The end
π °οΈ The risk of clinically significant QTp or TdP appears to be overstated
π ±οΈ 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
βοΈ Lots of evidence supporting π
The end
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