Formulary
Droperidol: Indications, Dosing, Side Effects and Interactions
Droperidol is a butyrophenone, structurally related to haloperidol, which blocks dopamine receptors in the chemoreceptor trigger zone.
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Droperidol: Indications, Dosing, Side Effects and Interactions
Droperidol is a butyrophenone, structurally related to haloperidol, which blocks dopamine receptors in the chemoreceptor trigger zone.
Drug action
Droperidol is a butyrophenone, structurally related to haloperidol, which blocks dopamine receptors in the chemoreceptor trigger zone.
Indications and dose
**Prevention and treatment of postoperative nausea and vomiting**
- **Adult** (By Intravenous Injection): 0.625-1.25 mg, dose to be given 30 minutes before end of surgery, then 0.625-1.25 mg every 6 hours as required.
- **Elderly** (By Intravenous Injection): 625 micrograms, dose to be given 30 minutes before end of surgery, then 625 micrograms every 6 hours as required.
**Prevention of nausea and vomiting caused by opioid analgesics in postoperative patient-controlled analgesia (PCA)**
- **Adult** (By Intravenous Injection): 15-50 micrograms of droperidol for every 1 mg of morphine in PCA, reduce dose in elderly; maximum 5 mg per day.
**Prevention and treatment of postoperative nausea and vomiting for droperidol**
- **Child 2-17 years** (By intravenous injection): 20-50 micrograms/kg (max. per dose 1.25 mg), dose to be given 30 minutes before end of surgery, then 20-50 micrograms/kg every 6 hours (max. per dose 1.25 mg) if required.
Cautions
For all antipsychotic drugs Blood dyscrasias; cardiovascular disease; conditions predisposing to seizures; depression; diabetes (may raise blood glucose); epilepsy; history of jaundice; myasthenia gravis; Parkinson's disease (may be exacerbated); photosensitisation (may occur with higher dosages); prostatic hypertrophy; severe respiratory disease; susceptibility to angle-closure glaucoma Cautions, further information Cardiovascular disease An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for all antipsychotics (other than quetiapine and clozapine) in patients with parkinsonism or Lewy Body Disease (risk of severe extrapyramidal symptoms) in behavioural and psychological symptoms of dementia (BPSD), unless symptoms are severe and other non-pharmacological treatments have failed (increased risk of stroke) for use as a hypnotic, unless sleep disorder is due to psychosis or dementia (risk of confusion, hypotension, extrapyramidal side-effects, and falls) in patients prone to falls (may cause gait dyspraxia, parkinsonism) if prescribed a phenothiazine (other than prochlorperazine for nausea, vomiting, or vertigo; chlorpromazine for relief of persistent hiccups; levomepromazine as an antiemetic in palliative care) as first-line treatment (sedative, significant antimuscarinic (anticholinergic) toxicity in older people, and safer and more efficacious alternatives exist) if prescribed an antipsychotic drug with moderate or marked antimuscarinic effects (e.g. chlorpromazine, clozapine, flupenthixol, fluphenazine, pipothiazine, promazine, and zuclopenthixol) in patients with a history of prostatism or urinary retention (high risk of urinary retention) Cautions For droperidol Chronic obstructive pulmonary disease; CNS depression; electrolyte disturbances; history of alcohol abuse; respiratory failure
Contraindications
Bradycardia; comatose states; hypokalaemia; hypomagnesaemia; phaeochromocytoma; QT-interval prolongation
Side effects
For all antipsychotic drugs Common or very common Agitation; amenorrhoea; arrhythmias; constipation; dizziness; drowsiness; dry mouth; erectile dysfunction; fatigue; galactorrhoea; gynaecomastia; hyperglycaemia; hyperprolactinaemia; hypersalivation; hypotension (dose-related); insomnia; leucopenia; movement disorders; muscle rigidity; neutropenia; parkinsonism; postural hypotension (dose-related); QT interval prolongation; rash; seizure; tremor; urinary retention; vomiting; weight increased Uncommon Agranulocytosis; confusion; neuroleptic malignant syndrome (discontinue-potentially fatal) Rare or very rare Sudden death; withdrawal syndrome neonatal Side-effects, further information For depot antipsychotics-side-effects may persist until the drug has been cleared from its depot site. Overdose Phenothiazines cause less depression of consciousness and respiration than other sedatives. Hypotension, hypothermia, sinus tachycardia, and arrhythmias may complicate poisoning. For details on the management of poisoning see Antipsychotics under Emergency treatment of poisoning . Side-effects For droperidol Uncommon Anxiety; oculogyration Rare or very rare Blood disorder; cardiac arrest; dysphoria Frequency not known Coma; epilepsy; hallucination; oligomenorrhoea; respiratory disorders; SIADH; syncope
Interactions
**Other interactions (9):**
- Examples include: - Class IA antiarrhythmics e.g.
- Consumption of alcoholic beverages and medicines should be avoided.
- Caution is advised when droperidol is used with any other medication known to prolong the QT interval.
- To reduce the risk of QT prolongation, caution is necessary when patients are taking medicinal products likely to induce electrolyte imbalance (hypokalaemia and/or hypomagnesaemia) e.g.
- Droperidol may potentiate the action of sedatives (barbiturates, benzodiazepines, morphine derivatives).
- Like other sedatives, droperidol may potentiate respiratory depression caused by opioids.
Pregnancy
For all antipsychotic drugs Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress.
Breast feeding
For all antipsychotic drugs There is limited information available on the short- and long-term effects of antipsychotic drugs on the breast-fed infant. Animal studies indicate possible adverse effects of antipsychotic medicines on the developing nervous system. Chronic treatment with antipsychotic drugs whilst breast-feeding should be avoided unless absolutely necessary. Phenothiazine derivatives are sometimes used in breast-feeding women for short-term treatment of nausea and vomiting. Breast feeding For droperidol Limited information available-avoid repeated administration.
Hepatic impairment
Manufacturer advises caution. Dose adjustments When used for Prevention and treatment of postoperative nausea and vomiting: Manufacturer advises maximum 625 micrograms repeated every 6 hours as required. When used for Prevention of nausea and vomiting caused by opioid analgesics in postoperative patient-controlled analgesia: Manufacturer advises dose reduction (no information available).
Renal impairment
Dose adjustments When used for Prevention and treatment of postoperative nausea and vomiting: Maximum 625 micrograms repeated every 6 hours as required. M When used for Prevention of nausea and vomiting caused by opioid analgesics in postoperative patient-controlled analgesia: Reduce dose (no information available). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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