DROPERIDOL
(droe-per'i-dole)
Inapsine
Classifications: central nervous system agent; butyrophenone; antiemetic
Prototype: Haloperidol
Pregnancy Category: C

Availability

2.5 mg/mL injection

Actions

Butyrophenone derivative structurally and pharmacologically related to haloperidol. Antagonizes emetic effects of morphine-like analgesics and other drugs that act on chemoreceptor trigger zone. Mild alpha-adrenergic blocking activity and direct vasodilator effect may cause hypotension. Acts primarily at subcortical level to produce sedation.

Therapeutic Effects

Sedative property reduces anxiety and motor activity without necessarily inducing sleep; patient remains responsive. Potentiates other CNS depressants. Also has antiemetic properties.

Uses

To produce tranquilizing effect and to reduce nausea and vomiting during surgical and diagnostic procedures. Also for premedication, during induction, and as adjunct in maintenance of general or regional anesthesia. Principally used in fixed combination with the potent narcotic analgesic fentanyl (Innovar) to produce neuroleptanalgesia (quiescence, reduced motor activity, and indifference to pain and environmental stimuli) to permit carrying out a variety of diagnostic and minor surgical procedures.

Unlabeled Uses

IV antiemetic in cancer chemotherapy.

Contraindications

Known intolerance to droperidol. Safe use during pregnancy (category C), lactation, or in children <2 y is not established.

Cautious Use

Older adult, debilitated, and other poor-risk patients; Parkinson's disease; hypotension; liver, kidney, cardiac disease; cardiac bradyarrhythmias.

Route & Dosage

Premedication
Adult: IV/IM 2.5–10 mg 30–60 min preoperatively
Child: IV/IM 2–12 y, 0.088–0.165 mg/kg 30–60 min preoperatively

Maintenance of General Anesthesia
Adult: IV/IM Induction, 0.22–0.275 mg/kg; Maintenance, 1.25–2.5 mg
Child: IV/IM 2–12 y, 0.088–0.165 mg/kg

Administration

Intramuscular

Give deep IM into a large muscle.

Intravenous

IV administration to infants and children: Verify correct rate of IV injection with physician.

PREPARE: Direct: Give undiluted.

ADMINISTER: Direct: Give at a rate of 10 mg or fraction thereof over 30–60 s.

INCOMPATIBILITIES Solution/additive: Fluorouracil, furosemide, heparin, leucovorin, methotrexate, pentobarbital. Y-site: Fluorouracil, furosemide, heparin, leucovorin, methotrexate, nafcillin.

Store at 15°–30° C (59°–86° F), unless otherwise directed by manufacturer. Protect from light.

Adverse Effects (1%)

CNS: Postoperative drowsiness, extrapyramidal symptoms: dystonia, akathisia, oculogyric crisis; dizziness, restlessness, anxiety, hallucinations, mental depression. CV: Hypotension, tachycardia, irregular heartbeats (prolonged QTc interval even at low doses). Other: Chills, shivering, laryngospasm, bronchospasm.

Pharmacokinetics

Onset: 3–10 min. Peak: 30 min. Duration: 2–4 h; may persist up to 12 h. Distribution: Crosses placenta. Metabolism: Metabolized in liver. Elimination: Excreted in urine and feces.

Nursing Implications

Assessment & Drug Effects

Monitor ECG throughout therapy. Report immediately prolongation of QTc interval.
Monitor vital signs closely. Hypotension and tachycardia are common adverse effects.
Exercise care in moving medicated patients because of possibility of severe orthostatic hypotension. Avoid abrupt changes in position.
Observe patients for signs of impending respiratory depression carefully when receiving a concurrent narcotic analgesic carefully.
Note: EEG patterns are slow to return to normal during the postoperative period.
Observe carefully and report promptly to physician early signs of acute dystonia: Facial grimacing, restlessness, tremors, torticollis, oculogyric crisis. Extrapyramidal symptoms may occur within 24–48 h postoperatively.
Note: Droperidol may aggravate symptoms of acute depression.

Patient & Family Education

Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug