For many years, droperidol has been a valuable tool for nausea, vomiting, headache, and termination of psychosomatic contributors to patient distress. Alas, droperidol availability has been markedly diminished in the U.S. in recent years, depriving us of one of our most efficacious management tools.
But, we still have plenty of haloperidol. So, let’s use it for the same purposes.
What’s the difference between droperidol and haloperidol? From a pharmacologic standpoint, the metabolism of haloperidol to active and toxic metabolites is far more complex than droperidol. But, from a clinical standpoint, there is very little difference – they are both butyrophenones with similar receptor antagonism.
This paper is not terribly robust, but compares the use of haloperidol against metoclopramide for acute headache in the Emergency Department. After pre-treatment with 25mg of IV diphenhydramine, either 10mg of IV metoclopromide or 5mg IV haloperidol was administered in double-blinded fashion. Owing to the small sample size of 64 patients, all measures of pain reduction, nausea, restlessness, and sedation were statistically equivalent between groups, although 8 of 33 of the metoclopromide cohort required rescue medications, compared with just 1 of 31 in the haloperidol cohort. However, telephone follow-up of patients following discharge also found the sedation and restlessness symptoms were more persistent in the haloperidol group compared with metoclopramide.
But, regardless, most of these differences – or lack thereof – is all small sample-size theatre. However, in addition to anachronistic anesthesia research into post-operative nausea and vomiting, this reasonably reinforces what we already know: if you’ve been suffering the loss of droperidol, you ought now be using haloperidol.
“A Randomized Controlled Trial of Intravenous Haloperidol vs. Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department.”
http://www.ncbi.nlm.nih.gov/pubmed/26048068
can't get haldol in our area of indiana, it's on shortage.
In my experience, Droperidol was a more effective treatment for delirium than haloperidol
Bummer.
There's at least one trial of olanzapine for undifferentiated headache in the ED, and it seems efficacious. I would wonder if it has some of the same effects as haloperidol and droperidol, but I'm not well-versed enough in its pharmacology to say.
There are differences in onset and duration, along with the first-pass metabolism for haloperidol, so individual patient effects likely vary.
It's a wonderful way to be updated and active.
GE 8C
I've been using ziprasadone (Geodon) for a couple years now with great success for migraine. Works great for gastroparesis and any persistent vomiting. Similar 5HT-1D receptor antagonistic activity like the triptans. Non one's "allergic" to it quite yet. I still like haloperidol but ziprasadone has a favorable side effect profile (less restlessness). Ziprasadone is $30 vs $5 for haloperidol though for the IM injections. Love to see a paper on it!
How many milligrams of Geodon do you mind?