The bearer of a black box and the scourge of Pharmaceutical and Therapeutics committees, droperidol has a long history – a history where, for the most part, it is used safely for decades.
This is a small case series from a prospective trial of treatment for acute agitation in the Emergency Department. In this study, patients requiring treatment for agitation received 10mg of IM droperidol as an initial dose, followed by a second dose within 15 minutes as needed, and further doses of droperidol as needed and in consultation with a toxicologist. An ECG was obtained, and continuous telemetry monitoring was applied as soon as safely possible.
42 patients qualified for droperidol in this study, 29 of whom received 10mg of droperidol, 11 received 20mg, 3 received 30mg, and 3 received 40mg. Of these, 4 patients receiving 10mg or 20mg had prolonged QT observed on ECG – to a maximum of 534ms. The authors write, then, in their conclusion: “QT prolongation was observed with high-dose droperidol.”
A more accurate conclusion, however, would probably be: “In a limited case series, no dose-dependent relationship between droperidol and QT prolongation was observed. QT prolongation of uncertain clinical significance was noted in a small number, but confounding co-ingestants limit the reliability of this finding.”
There ought to be, at this point, little legitimate concern over the clinical significance of the QT prolonging effects of these medicines in nearly all clinical situations. Thanks to Ariel Cohen for sending this in!
“High dose droperidol and QT prolongation: analysis of continuous 12-lead recordings”
http://www.ncbi.nlm.nih.gov/pubmed/24168079