droperidol (Dridol / Xomolix)

QTc interval changes following low-dose droperidol administration in the emergency department.

Bartoe Aaron A, Berkvens Laura L, Solano Aimee A, Hacnik Justin J et al.

Addition of lidocaine to prophylactic ondansetron and dexamethasone in high-risk adults for postoperative nausea and vomiting: a randomized, controlled, double-blinded study.

Yi Ke-Xin KX, Du Ming-Cheng MC, Zheng Jia J, Long Xiang X et al.

A triple combination of dexamethasone, ondansetron, and droperidol is recommended as prophylaxis to prevent postoperative nausea and vomiting in high-risk patients. However, the administration of droperidol is controversial owing to its fatal side effects. Considering the antiemetic effect of lidocaine, the aim of this study was to determine if its incorporation could mitigate postoperative nausea and vomiting in adults at high risk. This randomized, controlled, double-blind study was conducted from 10 June 2023 to 31 October 2023. Based on a preliminary experiment, 260 patients were enrolled in the trial, with 130 in group C (saline) and 130 in group L (lidocaine). The primary outcome was the incidence of postoperative nausea and vomiting at 24 hours postoperatively. The secondary outcomes were the Quality of Recovery-40 (QoR-40) score at 24 hours postoperatively and the time to extubation. Adverse events that occurred during the study were recorded. The incidence of postoperative nausea and vomiting differed between the groups, with 26.6% (33 patients) in group C and 16.4% (21 patients) in group L (P = 0.0484). The QoR-40 score was 176.45 ± 10.87 in group C and 186.59 ± 9.79 in group L (P < 0.001). No adverse events were observed during the trial. In high-risk patients, the addition of lidocaine to ondansetron and dexamethasone effectively reduced the incidence of postoperative nausea and vomiting and improved the quality of recovery.

Effectiveness and Safety of Droperidol Use in the VA Greater Los Angeles Healthcare System Emergency Department.

Minoda Emily E, Kono Shogo S, Pham My-Phuong MP, Acharya Hemang H et al.

Droperidol, a butyrophenone antipsychotic, is used for postoperative nausea and vomiting and as a sedative, anxiolytic, and analgesic. Concerns about potential QTc (corrected QT interval) prolongation led the US Food and Drug Administration (FDA) to issue a boxed warning and halt manufacturing. However, recent studies have supported droperidol's safety and it was reintroduced in 2019. Given the limited available options for managing acute agitation at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), there has been interest in re-evaluating the risks associated with droperidol use for sedation, anxiolysis, analgesia, and as an antiemetic. This retrospective chart review examined patients who received droperidol in the VAGLAHS emergency department (ED) from February 2021 to April 2023. The primary outcome was all-cause mortality after droperidol administration within 24 hours. Secondary outcomes included the efficacy of droperidol, incidence of QT prolongation, incidence of extrapyramidal symptoms (EPS) such as akathisia, dystonia, parkinsonism or tardive dyskinesia, and incidence of respiratory depression. Of 207 patients receiving droperidol, 38 (18.4%) were adults aged ≥ 65 years. Droperidol was used for acute agitation in 183 patients (88.4%) and as an antiemetic in 24 (11.6%) patients. No deaths were observed following droperidol administration in a 24-hour period. The need for rescue medication occurred in 15 patients (7.3%). EPS such as tardive dyskinesia and dystonia occurred in 2 (1.0%) patients. No arrhythmias or respiratory depression were observed within 24 hours of administration. No clinically relevant QTc prolongation was observed. No fatalities were seen among patients who received droperidol in the VAGLAHS ED. Despite the boxed warning issued by the FDA, these findings suggest droperidol is safe and effective in managing agitation and as an antiemetic.

Efficacy and safety of intramuscular and intravenous midazolam for acute agitation in emergency settings: a systematic review.

Bottaro Federico F, Nosari Guido G, Tesic Isidora I, Brambilla Paolo P et al.

Acute agitation often requires parenteral sedation in emergency care. Midazolam is widely used for its rapid onset, short duration of action, and availability for intramuscular and intravenous administration, but its efficacy and safety across emergency settings remain incompletely understood. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Scopus, and Web of Science for original studies evaluating intramuscular or intravenous midazolam, as monotherapy or in combination regimens, for acute agitation in emergency department (ED), psychiatric emergency service (PES), and prehospital emergency medical service (EMS) settings. Twenty-three studies met the inclusion criteria. Intramuscular midazolam was generally associated with rapid early sedation in ED studies, although this advantage was sometimes offset by less sustained clinical effects and higher need for rescue or additional sedation. Intravenous midazolam monotherapy showed a greater need for active airway management in its main direct comparison with intravenous droperidol. Midazolam-droperidol combinations showed more consistent advantages for rapid early sedation in monitored ED settings. In PES and EMS, midazolam's role was more dependent on clinical context, operational constraints and postsedation monitoring. Midazolam appears a useful rapid-onset option, but should not be considered a consistently superior standalone strategy. Future multicenter studies should better elucidate its safest and most effective use.