Cardiovascular Effects of Droperidol: A Clinically-Focused Review for the Consultation-Liaison and Emergency...

Droperidol carries a black box warning from the US Food and Drug Administration regarding the risk for corrected QT (QTc) prolongation and torsades de pointes but is experiencing a resurgence of use for agitation in emergency medicine settings.

This structured review aims to investigate effects of droperidol on cardiac conduction and risk of arrhythmias when used at standard doses.

We searched PubMed from inception through February 2025. We included studies describing cardiac effects or changes in vital signs in the setting of droperidol usage, excluding those involving other QTc-prolonging medications that lacked independent examination of droperidol effects. Two reviewers assessed articles and extracted data.

Forty-nine articles were included-18 randomized controlled trials, 3 nonrandomized trials, 19 observational studies, 7 case reports/series, and 2 Cochrane meta-analyses-with 41,878 individuals taking droperidol. Data were highly heterogenous, but QTc prolongation was observed in all levels of literature. Several randomized controlled trials suggested QTc prolongation of 10-25 ms at doses less than 10 mg. Evidence of increased risk for arrhythmias or sudden cardiac death was not present. Mixed effects were seen on vital signs.

Despite practical advantages for agitation, the use of droperidol is associated with moderate- to high-risk QTc prolongation, comparable to ziprasidone and greater than intravenous haloperidol. Although droperidol use does not appear to be associated with an increased risk for arrhythmia, alternative agents may be preferred in patients with other risk factors for arrhythmias. Consultation-liaison and emergency psychiatrists should be familiar with these risks.