Effectiveness and Safety of Droperidol Use in the VA Greater Los Angeles Healthcare System Emergency Department

Droperidol, a butyrophenone antipsychotic, is used for postoperative nausea and vomiting and as a sedative, anxiolytic, and analgesic. Concerns about potential QTc (corrected QT interval) prolongation led the US Food and Drug Administration (FDA) to issue a boxed warning and halt manufacturing. However, recent studies have supported droperidol's safety and it was reintroduced in 2019. Given the limited available options for managing acute agitation at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS), there has been interest in re-evaluating the risks associated with droperidol use for sedation, anxiolysis, analgesia, and as an antiemetic.

This retrospective chart review examined patients who received droperidol in the VAGLAHS emergency department (ED) from February 2021 to April 2023. The primary outcome was all-cause mortality after droperidol administration within 24 hours. Secondary outcomes included the efficacy of droperidol, incidence of QT prolongation, incidence of extrapyramidal symptoms (EPS) such as akathisia, dystonia, parkinsonism or tardive dyskinesia, and incidence of respiratory depression.

Of 207 patients receiving droperidol, 38 (18.4%) were adults aged ≥ 65 years. Droperidol was used for acute agitation in 183 patients (88.4%) and as an antiemetic in 24 (11.6%) patients. No deaths were observed following droperidol administration in a 24-hour period. The need for rescue medication occurred in 15 patients (7.3%). EPS such as tardive dyskinesia and dystonia occurred in 2 (1.0%) patients. No arrhythmias or respiratory depression were observed within 24 hours of administration. No clinically relevant QTc prolongation was observed.

No fatalities were seen among patients who received droperidol in the VAGLAHS ED. Despite the boxed warning issued by the FDA, these findings suggest droperidol is safe and effective in managing agitation and as an antiemetic.