Droperidol for Agitation in Older Adults in the Emergency Department

Droperidol is safe and effective for the treatment of severely agitated patients in the ED [1-3]. But what about its use for agitation in elderly patients specifically? Droperidol Efficacy Two Australian studies evaluated droperidol in more than 200 older adults (≥ 65 years old) in the prehospital and ED settings [4,5]. Both studies found droperidol [+]

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Droperidol is safe and effective for the treatment of severely agitated patients in the ED [1-3]. But what about its use for agitation in elderly patients specifically?

Droperidol Efficacy

Two Australian studies evaluated droperidol in more than 200 older adults (≥ 65 years old) in the prehospital and ED settings [4,5]. Both studies found droperidol to be effective in elderly patients with acute behavioral disturbances. The median time to sedation was ~20-30 minutes with doses ranging from 2.5-10 mg (Table 1). 

Characteristic Page, et al (n=162) Calver, et al (n=47)
Median Age 78 years 81 years
Initial Droperidol IM Dose 5 mg 10 mg (n=30)
5 mg (n=15)
2.5 mg (n=2)
Median Time to Sedation 19 mins 10 mg: 30 mins
5 mg: 21 mins
2.5 mg: NA
Patients Sedated with ≤ 10 mg Droperidol 144 (89%) 34 (72%)

Table 1: Efficacy of droperidol in older adults

Droperidol Safety

Additionally, each study broke down each time a patient experienced an adverse event (Table 2). Overall, these adverse events were uncommon (4.5%), mild in nature, and resolved spontaneously or with minor interventions. No patients developed Torsades de Pointes. 

Study Age/Sex Droperidol Dose Adverse Events Management Time Post-Droperidol
Page, et al (n=162) 76 yo Male 5 mg SBP <90 (88/54) Spontaneous Resolution
87 yo Female 10 mg SBP <90 (80/46) Spontaneous Resolution
79 yo Female 5 mg SBP <90 (83/48)
O2 sat <90% (80%)
Supplemental Oxygen
500 mL IV Fluid
82 yo Male 5 mg RR <12 (RR 10) Spontaneous Resolution
86 yo Male 5 mg O2 sat <90% (88%) Supplemental Oxygen
Calver, et al (n=49) 75 yo Male 10 mg SBP <90 30 mins
68 yo Female 10 mg SBP <90 5 mins
73 yo Male 10 mg Airway Obstruction 100 mins
87 yo Female 2.5 mg Oversedation 480 mins

Table 2: Safety of droperidol in older adults

Bottom Line

Taking the above points into account, droperidol appears to be both effective and safe in agitated adults ≥ 65 years of age for the treatment of agitation. The study authors recommend starting with 5 mg and repeating, if necessary, rather than initially using a dose of 10 mg.

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References

  1. Perkins, J., Ho, J. D., Vilke, G. M., & DeMers, G. (2015). American academy of emergency medicine position statement: Safety of droperidol use in the emergency department. The Journal of Emergency Medicine, 49(1), 91–97. doi: 10.1016/j.jemermed.2014.12.024. PMID: 25837231.
  2. PharmERToxGuy. Onset of IM Medications for Severe Agitation. Posted Dec 12, 2019.
  3. PharmERToxGuy. QTc Prolongation and Torsades de Pointes with Droperidol in the Emergency Department. Posted Aug 30, 2020.
  4. Calver, L., & Isbister, G. K. (2013). Parenteral sedation of elderly patients with acute behavioral disturbance in the ED. The American Journal of Emergency Medicine31(6), 970–973. doi: 10.1016/j.ajem.2013.03.026. PMID: 23685060.
  5. Page, C. B., Parker, L. E., Rashford, S. J., Kulawickrama, S., Isoardi, K. Z., & Isbister, G. K. (2020). Prospective study of the safety and effectiveness of droperidol in elderly patients for pre-hospital acute behavioural disturbance. Emergency Medicine Australasia: EMA32(5), 731–736. doi: 10.1111/1742-6723.13496. PMID: 32216048.

Author information

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules and EM Pharm Pearls Series
Attending Pharmacist, EM and Toxicology, MGH
Associate Professor of EM, Division of Medical Toxicology, Harvard Medical School

The post Droperidol for Agitation in Older Adults in the Emergency Department appeared first on ALiEM.

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