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 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
- 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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