Nurses Compass
Drug Guide
Droperidol
Classification
Therapeutic: Antipsychotic, antiemetic
Pharmacological: Butyrophenone dopamine antagonist
FDA Approved Indications
- Preoperative sedation
- Nausea and vomiting associated with surgery or diagnostic procedures
Mechanism of Action
Droperidol blocks dopamine receptors (D2) in the chemoreceptor trigger zone and the brain's limbic system, producing sedation and antiemetic effects.
Dosage and Administration
Adult: Initial dose of 0.625 to 2.5 mg IV or IM; additional doses can be administered every 4-8 hours as needed, not to exceed 15 mg/day.
Pediatric: Use is not well established; consult specific pediatric protocols and guidelines.
Geriatric: Start at lower doses due to increased sensitivity; monitor closely.
Renal Impairment: Use with caution; adjust dose based on clinical response.
Hepatic Impairment: Use with caution; dose adjustment may be necessary.
Pharmacokinetics
Absorption: Well absorbed IM; IV administration provides immediate effect.
Distribution: Widely distributed; crosses blood-brain barrier.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily in urine.
Half Life: Approximately 2-4 hours.
Contraindications
- Known hypersensitivity to droperidol or other butyrophenones.
- Prolonged QT interval or history of QT prolongation or cardiac arrhythmias.
Precautions
- Use with caution in patients with cardiovascular disease, electrolyte disturbances, or conditions predisposing to arrhythmias.
- Monitor ECG in at-risk patients.
Adverse Reactions - Common
- Drowsiness, sedation (Common)
- Vomiting, nausea (Common)
Adverse Reactions - Serious
- QT prolongation, Torsades de Pointes (Serious but rare)
- Hypotension (Uncommon)
- Extrapyramidal symptoms (Uncommon)
Drug-Drug Interactions
- Other medications prolonging QT interval (e.g., certain antibiotics, antifungals, class Ia and III antiarrhythmics).
Drug-Food Interactions
- None specifically noted.
Drug-Herb Interactions
- None well documented.
Nursing Implications
Assessment: Monitor EKG for QT prolongation, blood pressure, and neurological status.
Diagnoses:
- Risk for cardiac arrhythmias
Implementation: Administer IV or IM as ordered; monitor vital signs and cardiac rhythm closely.
Evaluation: Assess for effectiveness in nausea control and sedative effects; monitor for adverse reactions.
Patient/Family Teaching
- Report chest pain, palpitations, or dizziness.
- Avoid sudden movements if experiencing dizziness or sedation.
- Inform about potential QT prolongation and need for monitoring.
Special Considerations
Black Box Warnings:
- Significant risk of QT prolongation and Torsades de Pointes; contraindicated in patients with long QT syndromes or concurrent QT-prolonging drugs.
Genetic Factors: Genetic predispositions affecting cardiac repolarization may increase risk.
Lab Test Interference: May prolong QT interval on ECG.
Overdose Management
Signs/Symptoms: Severe hypotension, cardiac arrhythmias, extrapyramidal symptoms, excessive sedation.
Treatment: Supportive care; manage arrhythmias with appropriate antiarrhythmic drugs; correct electrolyte imbalances; provide symptomatic and supportive care.
Storage and Handling
Storage: Store at room temperature, protected from light.
Stability: Stable under recommended conditions.