Contributor: Sam Killian, MD

Educational Pearls:

• Droperidol (Inapsine) is an antipsychotic drug with efficacy for nausea, vomiting, headaches, and treating agitation
• In the early 2000's, Droperidol received a black box warning for QT prolongation
• This caused a precipitous drop of in administration and ultimately led to a stop in production
• More careful analysis since has called into question the true incidence of QT prolongation in typical dosing
• Retrospective review published this year looked at 15,374 non-critical and 1,172 critical patients who received droperidol with only a single episode of Torsades des pointes (which was attributed to multiple other risk factors)
• Of the 2,431 non-critical patients, and 396 critical patients, who received an ECG before and after administration, there were no changes to the mean QTc
• Droperidol is being manufactured again and the prior black box warning being called into question, so it will likely begin to become more widely available for use

References

Cole JB, Lee SC, Martel ML, Smith SW, Biros MH, Miner JR. The Incidence of QT Prolongation and Torsades des Pointes in Patients Receiving Droperidol in an Urban Emergency Department. West J Emerg Med. 2020 Jul 2;21(4):728-736. doi: 10.5811/westjem.2020.4.47036. PMID: 32726229; PMCID: PMC7390553.

Perkins J, Ho JD, Vilke GM, DeMers G. American Academy of Emergency Medicine Position Statement: Safety of Droperidol Use in the Emergency Department. J Emerg Med. 2015 Jul;49(1):91-7. doi: 10.1016/j.jemermed.2014.12.024. Epub 2015 Mar 30. PMID: 25837231.

Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD