Download DROPERIDOL

S . C . R . E . T . A . C . / S . E . C . R . E . T . A . C
M E D I C A L
T R E A T M E N T
P R O T O C O L S
DROPERIDOL
(INAPSINE)
U P D A T E D :
K .
W E B E R ,
3/10/2016
M D
D .
E
ACT ALLOWED
STANDING ORDER
E-IV
A
I
X
W I L S O N ,
M D
P
X
X
Classification
General Anesthetic
Pharmacology and Actions
1. Droperidol is a buyrophenone derivative closely related to haloperidol. Droperidol
produces a dopaminergic blockage, a mild alpha-adrenergic blockage, and causes
peripheral vasodilation. Its major actions are sedation, tranquilization, and potent
anti-emetic effect.
2. Onset of action is 3-10 minutes after IM or IV administration with peak effect in 30
minutes. Duration of the sedative effect is 2-4 hours.
Indications
1. To provide sedation in agitated or combative patients.
2. Intractable vomiting with transport time greater than 10 minutes.
Contraindications (in addition to having a known hypersensitivity to this medication or this
class of medication)
Any Patient:
1. With a suspected acute coronary syndrome
2. Systolic blood pressure under 100mm/Hg
3. Signs of sedation or respiratory depression
4. Known kidney or liver dysfunction
5. Known Parkinson’s Disease
Precautions
1. Due to the vasodilation effect, Droperidol can cause a transient hypotension that is
usually self-limiting and can be treated effectively with position and fluids.
Droperidol has also been known to cause tachycardia which usually does not require
pharmacologic intervention.
2. Some patients may experience dysphoria manifested as restlessness, hyperactivity,
or anxiety following Droperidol administration. Diphenhydramine 25mg may be
coadministered to alleviate these side effects.
3. Rare instances of neuroleptic malignant syndrome (very high fever, muscular
rigidity) have been known to occur after the use of Droperidol.
4. Side effects may be enhanced by rapid administration.
5. Droperidol will block the effectiveness of dopamine and causes a paradoxical
hypotension in the presence of epinephrine.
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S . C . R . E . T . A . C . / S . E . C . R . E . T . A . C
M E D I C A L
T R E A T M E N T
P R O T O C O L S
DROPERIDOL
(INAPSINE)
U P D A T E D :
K .
W E B E R ,
M D
3/10/2016
D .
W I L S O N ,
M D
How Supplied
1. 2.5mg/mL in a 2mL vial
Administration
***Continuous EKG monitoring is recommended. If not able to monitor cardiac
rhythm, document the reason***
***Consider administration of Diphenhydramine 25mg IV or IM***
Adult
1. Sedation
a. 5mg slow IV push or IM administration
b. After 10 minutes, if desired effect has not been achieved, contact Medical
Control to consider a second dose of 5mg.
2. Antiemetic
a. 1.25mg slow IV push or IM administration
b. Contact Medical Control to consider a second dose
Pediatric (12yrs and younger)
1. Sedation or Antiemetic
a. Contact Medical Control before administration of 0.05mg/kg slow IV or IM
Side Effects
1. Extra-pyramidal reactions have been noted hours to days after treat, usually
presenting as spasms of the muscles of the tongue, face, neck, and back.
Special Notes
1. Droperidol administration has been associated with QT prolongation and the
potential for ventricular arrhythmias including torsades de pointes.
2. Although extra-pyramidal reactions have an incidence less than 1% of the time and
usually present after the pre-hospital phase, be prepared to administer 50mg of
Diphenhydramine IVP/IM.
3. Hypotension and tachycardia secondary to Droperidol are usually self-limiting and
hypotension is correctable through recumbent positioning and fluid administration.
Be aware of other causes of hypotension and tachycardia, especially in the setting of
trauma.
4. The action of Droperidol potentiates the effects of sedative/tranquilizer type
medications and is relatively contraindicated in the known presence of these types
of medications. In this setting, monitor and treat respiratory depression, apnea,
muscular rigidity, and hypertension.
5. The elderly patient over 65 will respond more readily to Droperidol and a reduced
dose should be used. Consult with Medical Control to determine the appropriate
dose.
6. Zofran and IV fluids are the preferred treatment for nausea and vomiting in children
12 and under.
7. Droperidol has the potential to lower seizure threshold.
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