Written by Clay Smith
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This is yet another study with thousands of patients that found no increased risk of death using droperidol at usual, low doses.
Why does this matter?
Droperidol is effective and has antiemetic, sedative, and analgesic effects, as well as a 30-year track record of safety. But in 2001, the FDA effectively ended its use, with an iffy black box warning for QT prolongation and torsades risk. Some suspect GlaxoSmithKline may have had something to do with it, as ondansetron sales soared after droperidol was effectively nudged out of usage. You need to read this Academic EM exposé on the questionable circumstances surrounding the black-box warning for droperidol.
Droperidol – safe wonder-drug?
This was a retrospective study of 6,353 visits in which patients received droperidol. There were no deaths within 24 hours and no arrhythmias. As a secondary outcome, over 90% of patients required no rescue medications when it was used for headache or other pain, though this was based on manual review of 10% of charts. This study was focused more on safety and less on efficacy. The gist is droperidol is safe when given in usual lower doses: 0.625 to 2.5mg.
Source
Effectiveness and safety of droperidol in a United States emergency department. Am J Emerg Med. 2019 Nov 25. pii: S0735-6757(19)30612-6. doi: 10.1016/j.ajem.2019.09.007. [Epub ahead of print]
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I haven’t used this drug for anything but sedation/agitation control for years and we use 5-10 mg IM. This study doesn’t help us vis-a-vis safety.