Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Health and Drug Alerts

Droperidol: cardiovascular toxicity and deaths

Eric Wooltorton
CMAJ April 02, 2002 166 (7) 932;
Eric Wooltorton
Editorial Fellow, CMAJ
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Reason for posting: Health Canada has warned that the injectable form of droperidol, commonly used as a neuroleptic and antiemetic, has been associated with 8 deaths in Canada.1 The drug is also commonly used intramuscularly to treat migraine headache2 and to sedate combative patients3 including children and adolescents.4 Worldwide, more than 60 cases of QT prolongation, serious cardiac arrhythmias (e.g., torsades de pointes [TdP]) and sudden death have been reported in association with injectable droperidol.1 One international manufacturer, Janssen-Cilag, announced in March 2001 its discontinuation of droperidol production after chronic oral use of the drug by psychiatric patients was found to be associated with fatal cardiac arrhythmias. In December 2001 the US Food and Drug Administration announced that the warning labels for droperidol would be strengthened to recognize that cases of TdP were occurring even at doses of the drug below those recommended.5 Health Canada is assessing whether further regulatory action regarding droperidol is required in Canada.1

The drug: Droperidol is approved for use in Canada as a neuroleptic drug and is an effective antiemetic for postoperative nausea6 and nausea associated with Meniere's disease.7 It is available in Canada only in injectable forms. Droperidol is a butyrophenone and acts in part as a dopamine antagonist.6 It also inhibits α-adrenergic receptors, which leads to peripheral vasodilation (and possible hypotension). It acts within minutes of injection and has a half-life of 2.2–10 hours depending on its route of administration.4,8 As a neuroleptic it has known adverse effects including sedation, extrapyramidal symptoms (restlessness, akathisia, dystonia and occulogyric crises) and neuroleptic malignant syndrome.6,7 Droperidol is to be avoided in patients with liver or renal disease, Parkinson's disease or epilepsy.7 Cardiovascular effects of the drug may be due to delayed myocardial repolarization, with QT prolongation and increased risk of TdP.5 QT prolongation was apparently not mentioned in any of the reports of death in Canada, and other medications were concurrently being administered.1

What to do: Patients should be screened for a history of or risk factors for long QT syndrome. Patients predisposed to QT prolongation and TdP include those with electrolyte disturbances (low serum potassium or magnesium levels), bradycardia, cardiac conduction disturbances, congestive heart failure, cardiac hypertrophy, a history of alcohol abuse or recurrent blackouts, or a family history of sudden death. QT prolongation may also be more common in people 65 years and older and in those concomitantly using benzodiazepines, volatile anesthetics, intravenous opiates, antiarrhythmics (quinidine, sotalol or amiodarone), antipsychotics (thioridazine), some tricyclic antidepressants (amitriptyline), antibiotics (erythromycin, ketoconazole, moxifloxacin or pentamidine), antihistamines (astemizole or terfenadine), antiemetics (dolasetron), arsenic (for leukemia treatment) or migraine therapies (naratriptan). Droperidol should not be given to people whose baseline 12-lead electrocardiogram (ECG) reveals a QTc interval greater than 440 ms for males and 450 ms for females. Injectable droperidol should be used only in a hospital setting, where vital signs and ECG monitoring is available. The US manufacturer recommends 2–3 hours of cardiac monitoring after administration;9 however, the appropriate duration of monitoring is unclear (arrhythmias and QT prolongation have occurred up to 24 hours after the drug's administration), and it is unclear whether continuous monitoring will detect or prevent serious QT prolongation, arrhythmia and death.1

Eric Wooltorton Editorial Fellow, CMAJ

References

  1. 1.↵
    Cardiovascular toxicity with injectable droperidol. Ottawa: Health Canada; 2002 Feb 12. Available: www.hc-sc.gc.ca/hpb-dgps/therapeut/zfiles/english/advisory/tpd/droperidol_e.html (accessed 2002 Mar 5).
  2. 2.↵
    Vinson DR. Treatment patterns of isolated benign headaches in US emergency departments. Ann Emerg Med 2002;39(3):215-22.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Hick JL, Mahoney BD, Lappe M. Prehospital sedation with intramuscular droperidol: a one-year pilot. Prehosp Emerg Care 2001;5(4):391-4.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Hameer O, Collin K, Ensom MHH, Lomax S. Evaluation of droperidol in the acutely agitated child or adolescent. Can J Psychiatry 2001; 46(9): 864-5.
    OpenUrlPubMed
  5. 5.↵
    FDA strengthens warnings for droperidol [talk paper]. Rockville (MD): US Food and Drug Administration; 2001 Dec 6. Available: www.fda.gov/bbs/topics/ANSWERS/2001/ANS01123.html (accessed 2002 Mar 5).
  6. 6.↵
    Henzi I, Sonderegger J, Tramer MR. Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth 2000;47(6):537-51.
    OpenUrlCrossRefPubMed
  7. 7.↵
    Droperidol injection USP (2.5 mg/ml) neuroleptic-antiemetic [product monograph]. Boucherville (PQ): Sabex Inc; 1995 May 8.
  8. 8.↵
    Sawyer CA, Baker AB, Ramzan I, Regaglia F. Droperidol elimination after cardiopulmonary bypass surgery. J Clin Pharmacol 1998;38:160-5.
    OpenUrlCrossRefPubMed
  9. 9.↵
    Important drug warning [droperidol]. Buffalo Grove (IL): Akorn Pharmaceuticals; 2001 Dec 5. Available: www.fda.gov/medwatch/SAFETY/2001/inapsine.htm (accessed 2002 Mar 5).
PreviousNext
Back to top

In this issue

CMAJ
Vol. 166, Issue 7
2 Apr 2002
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Droperidol: cardiovascular toxicity and deaths
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Droperidol: cardiovascular toxicity and deaths
Eric Wooltorton
CMAJ Apr 2002, 166 (7) 932;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Droperidol: cardiovascular toxicity and deaths
Eric Wooltorton
CMAJ Apr 2002, 166 (7) 932;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Low-dose droperidol
  • Low-dose droperidol
  • Google Scholar

More in this TOC Section

  • Nefazodone (Serzone) withdrawn because of hepatotoxicity
  • Safety updates: repaglinide (GlucoNorm) and bicalutamide (Casodex)
  • Paroxetine (Paxil, Seroxat): increased risk of suicide in pediatric patients
Show more Health and Drug Alerts

Similar Articles

Collections

  • Topics
    • Cardiology: arrhythmias
    • Drugs: adverse reactions
    • Drugs: psychotherapeutic

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire