Pharmacist University of Washington Medical Center
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Introduction: Droperidol is used in emergency departments for acute agitation, nausea, vomiting, headaches, and abdominal pain. Despite an FDA black box warning for QT prolongation and torsades de pointes, serious cardiac events are rare at standard ED doses. This study aims to evaluate the safety and efficacy of droperidol use across UW Medicine EDs.
Methods: This retrospective chart review evaluated droperidol use for acute agitation in UW Medicine EDs from April 1, 2021, to April 1, 2024. Included were patients ≥18 years who received IV and IM droperidol (≥2.5 mg) at UW Medical Center Montlake (UWMC-ML), Harborview Medical Center (HMC), or UW Medical Center Northwest (UWMC-NW) for agitation, nausea, vomiting, headache, or abdominal pain, and remained in the ED ≥2 hours post-administration. Patients treated outside the ED were excluded. The primary outcome was the incidence of QTc prolongation (QTc >500 ms) and arrhythmias. Secondary outcome included adjunctive medication use within 30 minutes.
Results: The incidence of QTc prolongation (QTc >500 ms) was (20.45%, 95% CI [8.55%, 32.35%]) in females compared to males (14.29%, 95% CI [6.77%, 21.81%]), with an overall incidence of 16.41% (95% CI [9.99%, 22.83%]). The absolute risk of arrhythmias following droperidol administration was observed to be 5.47% in females (95% CI [2.68%, 8.25%]) and 7.93% in males (95% CI [5.25%, 10.61%]), with an overall incidence of 6.92% (95% CI [4.97%, 8.87%]). Notably, none of the arrhythmias were torsades de pointes. The overall absolute risk of requiring adjunctive medications for acute agitation within 30 minutes of droperidol administration was 5.85% (95% CI [4.05%, 7.65%]); comparable to or lower than adjunctive rates reported in studies with other antipsychotic and sedative agents.
Conclusions: This study confirms that while QTc prolongation (QTc >500 ms) occurs in some patients, the incidence of any arrhythmias remains low. Droperidol effectively manages acute agitation with minimal need for adjunctive medication. These findings support its continued use in emergency medicine, emphasizing the need for targeted cardiac monitoring in high-risk patients.
