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?
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
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%)
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
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.
Want to learn more about EM Pharmacology?
- 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.
- PharmERToxGuy. Onset of IM Medications for Severe Agitation. Posted Dec 12, 2019.
- PharmERToxGuy. QTc Prolongation and Torsades de Pointes with Droperidol in the Emergency Department. Posted Aug 30, 2020.
- Calver, L., & Isbister, G. K. (2013). Parenteral sedation of elderly patients with acute behavioral disturbance in the ED. The American Journal of Emergency Medicine, 31(6), 970–973. doi: 10.1016/j.ajem.2013.03.026. PMID: 23685060.
- 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: EMA, 32(5), 731–736. doi: 10.1111/1742-6723.13496. PMID: 32216048.
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