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). 

CharacteristicPage, et al (n=162)Calver, et al (n=47)
Median Age78 years81 years
Initial Droperidol IM Dose5 mg10 mg (n=30)
5 mg (n=15)
2.5 mg (n=2)
Median Time to Sedation19 mins10 mg: 30 mins
5 mg: 21 mins
2.5 mg: NA
Patients Sedated with ≤ 10 mg Droperidol144 (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. 

StudyAge/SexDroperidol DoseAdverse EventsManagementTime Post-Droperidol
Page, et al (n=162)76 yo Male5 mgSBP <90 (88/54)Spontaneous Resolution
87 yo Female10 mgSBP <90 (80/46)Spontaneous Resolution
79 yo Female5 mgSBP <90 (83/48)
O2 sat <90% (80%)
Supplemental Oxygen
500 mL IV Fluid
82 yo Male5 mgRR <12 (RR 10)Spontaneous Resolution
86 yo Male5 mgO2 sat <90% (88%)Supplemental Oxygen
Calver, et al (n=49)75 yo Male10 mgSBP <9030 mins
68 yo Female10 mgSBP <905 mins
73 yo Male10 mgAirway Obstruction100 mins
87 yo Female2.5 mgOversedation480 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.
Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

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

Leadership Team, ALiEM
Creator and Lead Editor, Capsules series, ALiEMU
Attending Pharmacist, EM and Toxicology, MGH
Assistant Professor of EM, Harvard Medical School
Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

@PharmERToxGuy

EM Pharmacist & Toxicologist @MassGeneralEM | Asst Prof @HarvardMed/@EMRES_MGHBWH | @ALiEMteam leadership | Capsules creator, ALiEMU | President, ABAT | #FOAMed
Mike O'Brien, PharmD

Mike O'Brien, PharmD

ALiEM Series Editor, EM Pharm Pearls
EM Clinical Pharmacist
Massachusetts General Hospital
Mike O'Brien, PharmD

@MikeEMPharmD

Emergency Medicine Pharmacist at MGH | #FOAMed | Thoughts & views are my own