Droperidol vs. haloperidol for abdominal pain

Haloperidol and droperidol are antipsychotic medications with multimodal pharmacodynamic effects making them useful in the emergency department (ED). Data suggests that droperidol and haloperidol may reduce morphine milliequivalents (MME) administered when used for undifferentiated abdominal pain (UAP) in the ED. However, there is a paucity of data comparing the two agents in this cohort. The purpose of this study was to assess the efficacy of haloperidol versus droperidol in reducing MME requirements for UAP in the ED.

This retrospective, single-center study included patients ≥18 years old who presented to the ED for UAP. Patients were excluded if they required urgent surgery or received haloperidol or droperidol for agitation. The primary outcome was the difference in MME administered in the ED between patients who received haloperidol versus droperidol. Secondary outcomes included rates of rescue antiemetics, rescue analgesics, admission to the hospital, hospital length of stay, and adverse effects.

A total of 100 patients were evaluated, with 50 patients receiving haloperidol and 50 patients receiving droperidol. Patients in the haloperidol group received a lower median MME compared to those in the droperidol group (0 MME [IQR 0-10] vs 10 MME [IQR 0-20], p-value 0.033). There was no statistical difference between secondary outcomes evaluated, including safety events.

Haloperidol was associated with a significant reduction in MME administration compared to droperidol for UAP in the ED. Large high-quality data sets are needed to confirm haloperidol's role in multimodal pain management of UAP compared to droperidol.